ESRA19-0358\u2005Sciatic block in AOCP patients: is an increase in regional saturation possible?

Abstract

Background and aims Peripheral artery disease is an abnormal narrowing of the arteries due to endothelium dysfunctions which result in vessel obstruction. PAD most commonly affects the legs. When recommended endovascular surgery represents goal standard and can be performed with regional anesthesia. Is it is well documented how local anesthetics used in RA techniques are responsible for the sensitive, motor and sympathetic blockade of the nerves which causes vasoplegia. This study aimed to evaluate variations of regional saturation, indicating peripheral vasodilatation, in PAD affected patients subjected to a sciatic block prior to endovascular procedures. Methods We conducted single-center prospective observational study to evaluate the improvement of peripheral vascular perfusion, monitored with near-infrared spectroscopy, in patients undergoing endovascular surgery after performing sciatic nervous block. 31 patients were enrolled from January 2017 to January 2019 from the Professor Righi’s Angiography Divison and Doctor Merlo’s Department of Vascular Surgery. On all patients treated, sciatic block was performed with 20 ml of Mepivacaine 1% and peripheral saturation monitored with NIRS periprocedurally. Results Mean baseline rSO2 was 58,12. After performing the sciatic popliteal block a mean of 62,12 rSO2 was obtained. After 15 minutes the average increase in rSO2 was 64,25, increasing to 66,47 at 30 minutes. At the end of the surgical procedure, mean rSO2 values were 67,63. Conclusions In this study we were able to observe an increase in NIRS values periprocedurally. This study gives an important input concerning the relevance of peripheral nerve block in complementing revascularization procedures and implementing peripheral reperfusion given local anesthetics vasoplegic and consequent vasodilatation properties.