Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter

Table 1

Summary of findings from included studies.

Study	Disease/sample size	Type of regional blockade	Quality of analgesia	Procedural complications
Observational studies
Kulkarni et al. 2010^a	PVD of UE (20 pts)	Multiple interval single-shot stellate ganglion blocks (injectate contained ketamine also)	Preblock VAS of 7 decreased to 4.25 postblock; mean duration of analgesia 7 h; 100% pain relief at 12^th week in 18/20 pts; complete healing of gangreneous fingers in 17/19 pts	Horner’s (12 pts), hoarseness (6 pts), hematoma (1 pt), bradycardia (2 pts), dizziness (16 pts)
Marcus et al. 2006	CLI in LE (25 pts)	Single-shot sciatic and femoral nerve block	All pts experienced reduction in ischemic rest pain permitting angioplasty without neuraxial anesthesia or GA; mean VAS 3.7 (scale 0–10)	None
Tureli et al. 2018	CLI in LE (30 pts)	Single-shot popliteal sciatic nerve block	VAS scores were 0 (no pain) in 87% of pts and 1–3 (mild to annoying pain) in 13% of pts	None
Case reports/series
Belsky et al. 2015	Blue toe syndrome from thromboembolus (1 pt)	Single-shot digital block	Significant alleviation of ischemic pain	None
Greengrass et al. 2003	Digital ischemia in scleroderma (1 pt)	Continuous ambulatory axillary nerve block	Significant alleviation of ischemic pain, 6-months following removal of catheter, no recurrence of pain or ischemic ulcers was observed	None
Han et al. 2008	Digital ischemia in scleroderma (1 pt)	Continuous thoracic sympathetic ganglion block	VAS scores improved from a peak of 6/10 to 1/10; healing of medically refractory digital gangrene	None
Hashimoto et al. 2011	CLI in LE (2 pts with 1 having Buerger’s disease)	Continuous popliteal sciatic nerve block which was changed to intermittent patient-controlled bolus	No pain alleviation with continuous infusion in both cases; pain alleviation noted with patient-controlled intermittent bolus in 1 case	None
Kucera and Boezaart 2014	Tight cast placement on right LE (1 pt); ischemia in right 4^th/5^th fingers (1 pt)	Single-shot sciatic and femoral nerve block; continuous C7 paravertebral block	No relief of ischemic pain in both cases despite dense motor and sensory blockade	None
Saddler and Crosse 1988	Digital ischemia in Buerger’s disease	Continuous ambulatory median nerve block	Significant alleviation of ischemic pain	None
Soberón et al. 2014	Digital ischemia of the 4^th/5^th fingers (1 pt)	Continuous supraclavicular nerve block (became dislodged), followed by single-shot axillary block	Modest relief of ischemic pain	None

Some included studies added another adjunct in the injectate or utilized liposomal bupivacaine; ^aKulkarni et al included patients with gangrene (atherosclerotic, thromboembolic, diabetic dry, and post-traumatic), Raynaud’s disease, and 1 CRPS patient and categorized them as having ischemic PVD. LE = lower extremity; UE = upper extremity; pts = patients; VAS = visual analog scale; PVD = peripheral vascular disease; h = hours; GA = general anesthesia.