Ultrasound-Guided Popliteal Sciatic Nerve Block: A Minimally Invasive Method for Pain Control During Endovascular Treatment of Critical Limb Ischemia

Abstract

Purpose: To evaluate the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block (PSNB) for pain control in endovascular treatment of critical limb ischemia (CLI).Materials and Methods: This retrospective study included 252 patients who underwent endovascular treatment for CLI between January 2020 and August 2022. Of these, 69 patients underwent PSNB, whereas moderate procedural sedation and analgesia was delivered in 183 patients. Pain scores were assessed using the visual analog scale (VAS) before and during the intervention. Technical and clinical success of PSNB, duration of the procedure, time to onset of nerve block, time for block resolution, and adverse events were recorded. Patient and operator satisfaction were assessed using the Likert scale.Results: All PSNB procedures were technically and clinically successful, and the mean procedural duration of PSNB was 5.0 minutes +/- 0.8 (range, 4-7 minutes). Prolonged effect of PSNB was observed in 3 patients, which resolved within 24 hours. No adverse events were encountered. Median VAS score was significantly lower in the PSNB group than in the moderate procedural sedation and analgesia group during endovascular treatment (0 [range, 0-2] vs 3 [range, 0-7]; P < .001). Patient satisfaction was comparable (very satisfied in 66 [95.7%] vs 161 [88.0%]; P = .069). However, operator satisfaction was significantly higher in the PSNB group (very satisfied in 69 [100%] vs 161 [88.0%]; P = .003).Conclusions: PSNB is safe and effective for pain control during endovascular treatment of CLI. Low adverse event rates with high patient and operator satisfaction make PSNB a reasonable alternative for high-risk patients.