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Background and Aims Inpatient and after discharge palliative care is essential to improve quality of end-of-life. Critical limb ischemia is associated with an excruciating pain. We describe the successful in-hospital and after discharge use of perineural sciatic nerve catheter to control refractory ischemic pain.
Methods Data was collected through consultation of clinical records.
Case report A 77-year-old female was admitted with decompensated heart failure (NYHA class IV) and respiratory failure requiring non-invasive ventilation. Medical history included atrial fibrillation, severe aortic stenosis, arterial hypertension, obesity, poorly controlled diabetes mellitus and bilateral chronic lower limb ischemia. Physical examination revealed necrosis of the right foot and ulcerations on the left one. Surgical treatment was refused, and conservative/confort measures were adopted. Despite morphine intravenous infusion, severe pain at rest and during wound dressing was referred. Chronic pain unit consultation was required, and continuous sciatic popliteal nerve block was proposed. Immediate relief was reported after the first bolus and a DIB with ropivacaine was initiated. Given the bad clinical prognosis and patient’s desire for home discharge, patient went home with perineural popliteal DIB of ropivacaine 0.1% 5mL/h (replaced every 3 days at the chronic pain unit) and fixed 5mg oral morphine including before wound dressing, performed by the primary healthcare team. Excellent pain efficacy (EN 2/10) and high level of patient and family’s satisfaction were reported.
Conclusions Home-based palliative care decreases readmissions and health care utilisation. Locoregional analgesia may be an effective tool establishing the bridge between acute and home-based palliative care for management of chronic pain at end-of-life patients.
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