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#36069 Management of ischemic pain in ambulatory with popliteal-sciatic perineural catheter – is it possible?
  1. Jorge Carteiro1,
  2. André Aguiar2 and
  3. Celia Xavier1
  1. 1Anesthesiology Department, Centro Hospitalar Universitário Lisboa Norte – Hospital de Santa Maria, Lisbon, Portugal
  2. 2Anesthesiology Department, Centro Hospitalar Universitário do Algarve – Hospital de Faro, Faro, Portugal


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Background and Aims Ischemic pain is the main symptom of peripheral arterial obstructive disease (PAOD) and affects the quality of life. It is hard to manage with systemic analgesics so continuous peripheral nerve block may be an effective alternative with fewer side effects.

Methods A 47-year-old female patient with hypertension, diabetes mellitus, dislipidemia and active smoking was diagnosed with critical limb ischemia and foot ulcer as a result of thrombosis of common iliac artery. She experienced severe pain in her foot and fingers, and the acute pain unit was called in to manage her pain before the surgery. A popliteal-sciatic perineural catheter was placed and we started a patient-controlled regional analgesia (5ml/hour + boluses 5ml lockout 30 minutes), after confirming pain relief with 15ml ropivacaine 0.2%

Results She evolved with better control of pain, requiring less opioids and adjuvants. Following five days in the hospital, the patient was discharged home with a drug infusion balloon (DIB) of ropivacaine 0.2% 5ml/h. The DIB was changed every two days during wound dressings at hospital. Despite the catheter was accidentally exteriorized it remained in place for 14 days without signs of infection or neurologic complications.

Conclusions Regional analgesia, such as continuous epidural analgesia through a catheter, has been used with good response, but with possible side effects. This cases highlights the benefits of continuous peripheral nerve block which offers the advantage of minimal adverse effects, emerges as a viable alternative that does not require the use of anticoagulants and allow the patients to take the catheter home.

  • Regional Anesthesia
  • Perineural catheter
  • Ischemic pain

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