RT Journal Article
SR Electronic
T1 #36337 Severe hand pain in iv-stage leriche-fontaine peripheral artery disease(pad): combination between regional anesthesia(RA) and ozone(O3) therapy for recovery of microcirculation. A case report
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A230
OP A231
DO 10.1136/rapm-2023-ESRA.426
VO 48
IS Suppl 1
A1 Mazzocchi, Marco
A1 Mascia, Benedetta
A1 Pariani, Eleonora
A1 Bruschi, Giacomo
A1 Quaretti, Pietro
A1 Locatelli, Alessandro
YR 2023
UL http://rapm.bmj.com/content/48/Suppl_1/A230.2.abstract
AB Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims PAD induces severe and disabling pain with gradual functional impairment and progressive circulation disorder leading to gangrene. Affection of microcirculation rarely develops an effective compensatory mechanism and can’t be treated surgically. RA reduces pain and induces vasodilation, acting on sympathetic and sensitive nerve fibers. O3 therapy promotes nitric oxide release resulting in vasodilation, improves O2 delivery and activates mediators involved in endothelial regeneration. We hypothesized that the combination of RA and O3 could be effective for pain relief and reactivation of microcirculation.Methods We treated 1 male patient(68y), with a critical, bilateral upper extremities PAD not amenable to revascularization surgery and with severe pain(NRS=10), poor responsive to drugs. Signs of chronic ischemia, including gangrene, were present. The last chance treatment was the amputation of both hands. We performed autohemotherapy(30 ml of blood + 30 ml of O2O3 blend at 40 mcg/ml of concentration) twice a week + digital nerve block with levobupivacaine 0,15% + subcutaneous infiltration of O2O3 at 10 mcg/ml.Abstract #36337 Figure 1 Hands before treatmentAbstract #36337 Figure 2 Hands after treatmentResults Following one week of treatment pain disappeared completely. After 2 months hands were warmer and well-perfused, areas of dry necrosis were delimited, granulation tissue appeared and eschars fell off from healthier skin. Doppler showed arterial flows. No collateral effects occurred. Maintenance therapy was once a week for 2 months.Conclusions The combination between RA and O3 therapy has shown to be a safe and an effective conservative treatment in managing pain and in the reactivation of microcirculation in this severe case of PAD, avoiding demolitive amputation surgery of both hands.