Prolonged paravertebral analgesia in therapy of chronic pain syndrome in critical lower-limb ischaemia

Priezzhev N.B.¹, Katelnitsky I.I.², Zorkin A.A.¹, Drozhzhin E.V.¹, Mazaishvili K.V.¹

1) Department of Faculty Surgery of Medical Institute, Sugrut State University of the Khanty-Mansi Autonomous Region-Yugra, Surgut,
2) Department of Surgical Diseases №1, Rostov State Medical University of the RF Ministry of Public Health, Rostov-on-Don, Russia

Chronic pain syndrome in patients presenting with lower-limb critical ischaemia may have considerable significance in progression of the degree of limb ischaemia, and quality of life of patients appears to be largely determined by adequate analgesia. Currently, there is no «gold standard» of therapy for chronic pain syndrome in critical lower-limb ischaemia, which makes it necessary to search for new effective and safe methods of analgesia.

The purpose of this study was to evaluate efficacy and safety of paravertebral analgesia compared with epidural analgesia in therapy of chronic pain syndrome in critical lower-limb ischaemia.

Our prospective randomized double-centre study included a total of 40 patients suffering from atherosclerotic-genesis critical lower-limb ischaemia and pronounced unilateral pain syndrome. The patients were randomized into two equal groups comprising 20 patients each. They were comparable by the main clinical and demographic parameters, as well as by the scope of the comprehensive treatment performed. In the study group, therapy of chronic pain syndrome was provided by the method of paravertebral analgesia, with the comparison group patients receiving epidural analgesia. Paravertebral analgesia was performed with the use of ultrasound navigation, in the prolonged mode by means of using microinfusion elastomeric pumps, epidural analgesia – according to the standard technique.

The use of various methods of analgesia was accompanied by a decrease in chronic pain syndrome according to the visual analogue scale by 60% within the first 24 hours, and by 65% at 72 hours thereafter, with the differences being statistically insignificant. The use of prolonged paravertebral analgesia was accompanied by neither considerable haemodynamic reactions nor the development of the motor block, however requiring significant expenditure of a local anaesthetic.

The conclusion was drawn that paravertebral analgesia in lower-limb critical ischaemia turned out to be a safe and efficient method of comprehensive therapy of chronic pain syndrome.

KEY WORDS: critical lower-limb ischaemia, chronic pain syndrome, paravertebral analgesia, epidural analgesia.

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