Progress of perioperative pain management in patients with lower limb vascular diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xia ¹ ,  WU Zhoupeng ²

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WU Zhoupeng, Email: lzwzp19@163.com

Keywords：

lower extremity vascular disease; perioperative period; pain management

DOI：

10.7507/1007-9424.202311092

Video：

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Objective To summarize the progress of perioperative pain management in patients with lower limb vascular diseases. Method Retrieved the literature about pain management in patients with lower limb vascular diseases both at home and abroad in recent years and reviewed the literature. Results Lower limb vascular diseases were very common in elderly patients. Whether it was limb ischemic pain or surgery-related pain, it often increased the stress response and activation of the autonomic system, which was not conducive to the recovery of the disease. Good analgesic management was important for these patients. Perioperative pain management could be performed by intravenous analgesics, oral analgesics, local anesthesia, neuraxial anesthesia and peripheral nerve block. Acute and chronic pain should be actively managed during perioperative period. Pre-emptive analgesic strategies could be implemented in patients with severe peripheral vascular disease. Conclusions Good perioperative analgesia management is necessary. Pain management which employes one or more analgesic methods is important in maximizing pain relief, function, and quality of life for this patient group.

Citation： WANG Xia, WU Zhoupeng. Progress of perioperative pain management in patients with lower limb vascular diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(4): 508-512. doi: 10.7507/1007-9424.202311092 Copy

1.	Boucher N, Dreksler H, Hooper J, et al. Anaesthesia for vascular emergencies—a state of the art review. Anaesthesia, 2023, 78(2): 236-246.
2.	Seretny M, Colvin LA. Pain management in patients with vascular disease. Br J Anaesth, 2016, 117 Suppl 2: ii95-ii106.
3.	De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022, 63(2): 184-267.
4.	Valencia L, Iturri F, Fàbregas N, et al. Anaesthesia and endovascular therapy in patients with acute ischaemic stroke. Eur J Anaesthesiol, 2019, 36(4): 305-306.
5.	Kietaibl S, Ferrandis R, Godier A, et al. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol, 2022, 39(2): 100-132.
6.	Horlocker TT, Vandermeuelen E, Kopp SL, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med, 2018, 43(3): 263-309.
7.	Joubert F, Gillois P, Bouaziz H, et al. Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: A systematic review. Anaesth Crit Care Pain Med, 2019, 38(5): 507-516.
8.	Laoire áN, Murtagh FEM. Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia. BMJ Support Palliat Care, 2018, 8(4): 400-410.
9.	Gedikoglu M, Eker HE. Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia. Pol J Radiol, 2019, 84: e537-e541. doi: 10.5114/pjr.2019.91271.
10.	Kikuchi S, Yamaguchi T, Miyake K, et al. Effectiveness and safety of ultrasound guided lower extremity nerve blockade in infragenicular bypass grafting for high risk patients with chronic limb threatening ischaemia. Eur J Vasc Endovasc Surg, 2019, 58(2): 206-213.
11.	Dos Santos Fernandes H, Lima Filho PEP, Gouvêa áL, et al. Continuous peripheral nerve block for upper limb ischemic pain: a case report. Braz J Anesthesiol, 2021, 71(4): 451-453.
12.	Fernandes HDS, Ximenes JLS, Taguchi PK, et al. Continuous peripheral nerve block for in-patients with lower limb ischemic pain. Clinics (Sao Paulo), 2021, 76: e2805. doi: 10.6061/clinics/2021/e2805.
13.	Abdullah O, Omran J, Al-Dadah AS, et al. Atherectomy-assisted versus percutaneous angioplasty interventions for treatment of symptomatic infra-inguinal peripheral arterial disease. Arch Med Sci Atheroscler Dis, 2019, 4: e231-e242. doi: 10.5114/amsad.2019.89900.
14.	Roberts DJ, Nagpal SK, Kubelik D, et al. Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study. BMJ, 2020, 371: m4104. doi: 10.1136/bmj.m4104.
15.	Naser A, Isgandarov K, ?tal ?, et al. Peripheral neural blockade for pain control in patients undergoing percutaneous angioplasty for complex infrapopliteal disease. Turk Kardiyol Dern Ars, 2021, 49(4): 321-327.
16.	Schroeder AR, Dehghan M, Newman TB, et al. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med, 2019, 179(2): 145-152.
17.	Fereydooni A, O’Meara T, Popescu WM, et al. Utilization and outcomes of local anesthesia and peripheral nerve block for hybrid lower extremity revascularization. J Endovasc Ther, 2020, 27(1): 94-101.
18.	Yazigi A, Madi-Gebara S, Haddad F, et al. Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks. J Clin Anesth, 2005, 17(7): 499-503.
19.	中華醫學會外科學分會血管外科學組, 中國醫師協會血管外科醫師分會, 中國醫療保健國際交流促進會血管外科分會, 等. 中國慢性靜脈疾病診斷與治療指南. 中華醫學雜志, 2019, 99(39): 3047-3061.
20.	中國醫師協會血管外科醫師分會靜脈學組. 常見靜脈疾病診治規范(2022年版). 中華血管外科雜志, 2022, 7(1): 12-29.
21.	Prochaska JH, Arnold N, Falcke A, et al. Chronic venous insufficiency, cardiovascular disease, and mortality: a population study. Eur Heart J, 2021, 42(40): 4157-4165.
22.	Salim S, Machin M, Patterson BO, et al. Global epidemiology of chronic venous disease: A systematic review with pooled prevalence analysis. Ann Surg, 2021, 274(6): 971-976.
23.	中華醫學會麻醉學分會老年人麻醉與圍術期管理學組, 國家老年疾病臨床醫學研究中心, 國家老年麻醉聯盟. 中國老年患者圍手術期麻醉管理指導意見(2020版)(二). 中華醫學雜志, 2020, 100(33): 2565-2578.
24.	Tran J, Chan VWS, Peng PWH, et al. Evaluation of the proximal adductor canal block injectate spread: a cadaveric study. Reg Anesth Pain Med, 2019, rapm-2019m-101091m. doi: 10.1136/rapm-2019-101091.
25.	Tran DQ, Salinas FV, Benzon HT, et al. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med, 2019, rapm-2018-000019. doi: 10.1136/rapm-2018-000019.
26.	張文婷, 袁婉秋. 超聲引導下隱神經阻滯在大隱靜脈剝脫術中的效果觀察. 中國當代醫藥, 2021, 28(21): 149-151,155.
27.	孔祥云, 隋成, 周晶, 等. 股神經聯合坐骨神經阻滯麻醉在大隱靜脈曲張剝脫術中的臨床應用效果. 檢驗醫學與臨床, 2022, 19(14): 1992-1995.
28.	Aherne TM, Ryan éJ, Boland MR, et al. Concomitant vs. staged treatment of varicose tributaries as an adjunct to endovenous ablation: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2020, 60(3): 430-442.
29.	De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology, 2014, 29(7): 428-441.
30.	Wright TF, Brunetti GF, Kennedy P. Lidocaine safety after saphenous vein tumescent anesthesia. Phlebology, 2019, 34(10): 683-689.
31.	Zhang YS, Chen PJ, Wan HL, et al. Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial. Phlebology, 2022, 37(7): 529-534.
32.	Lomarat N, Akaraprasertkul J, Wongchompoo N, et al. Ultrasound-guided femoral block in patients undergoing radiofrequency ablation of incompetent saphenous veins: A randomized controlled trial. Asian J Surg, 2023, 46(1): 174-179.
33.	Hurmerinta-Kurkij?rvi O, Weselius EM, Halmesm?ki K, et al. Femoral nerve blockade during endovenous laser ablation of great saphenous vein decreases pain but does not affect the use of opioids during the procedure. J Vasc Surg Venous Lymphat Disord, 2023, 11(5): 921-927.
34.	Oh S, Kwon W. Quadratus lumborum block enables complete anesthesia for radiofrequency ablation in varicose vein surgery. J Clin Anesth, 2019, 56: 151-152.
35.	中國微循環學會周圍血管疾病專業委員會. 聚桂醇注射液治療下肢靜脈曲張微循環專家共識. 血管與腔內血管外科雜志, 2020, 6(5): 377-381.
36.	de ávila Oliveira R, Riera R, Vasconcelos V, et al. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev, 2021, 12(12): CD001732. doi: 10.1002/14651858.CD001732.pub3.

1. Boucher N, Dreksler H, Hooper J, et al. Anaesthesia for vascular emergencies—a state of the art review. Anaesthesia, 2023, 78(2): 236-246.
2. Seretny M, Colvin LA. Pain management in patients with vascular disease. Br J Anaesth, 2016, 117 Suppl 2: ii95-ii106.
3. De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg, 2022, 63(2): 184-267.
4. Valencia L, Iturri F, Fàbregas N, et al. Anaesthesia and endovascular therapy in patients with acute ischaemic stroke. Eur J Anaesthesiol, 2019, 36(4): 305-306.
5. Kietaibl S, Ferrandis R, Godier A, et al. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol, 2022, 39(2): 100-132.
6. Horlocker TT, Vandermeuelen E, Kopp SL, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med, 2018, 43(3): 263-309.
7. Joubert F, Gillois P, Bouaziz H, et al. Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: A systematic review. Anaesth Crit Care Pain Med, 2019, 38(5): 507-516.
8. Laoire áN, Murtagh FEM. Systematic review of pharmacological therapies for the management of ischaemic pain in patients with non-reconstructable critical limb ischaemia. BMJ Support Palliat Care, 2018, 8(4): 400-410.
9. Gedikoglu M, Eker HE. Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia. Pol J Radiol, 2019, 84: e537-e541. doi: 10.5114/pjr.2019.91271.
10. Kikuchi S, Yamaguchi T, Miyake K, et al. Effectiveness and safety of ultrasound guided lower extremity nerve blockade in infragenicular bypass grafting for high risk patients with chronic limb threatening ischaemia. Eur J Vasc Endovasc Surg, 2019, 58(2): 206-213.
11. Dos Santos Fernandes H, Lima Filho PEP, Gouvêa áL, et al. Continuous peripheral nerve block for upper limb ischemic pain: a case report. Braz J Anesthesiol, 2021, 71(4): 451-453.
12. Fernandes HDS, Ximenes JLS, Taguchi PK, et al. Continuous peripheral nerve block for in-patients with lower limb ischemic pain. Clinics (Sao Paulo), 2021, 76: e2805. doi: 10.6061/clinics/2021/e2805.
13. Abdullah O, Omran J, Al-Dadah AS, et al. Atherectomy-assisted versus percutaneous angioplasty interventions for treatment of symptomatic infra-inguinal peripheral arterial disease. Arch Med Sci Atheroscler Dis, 2019, 4: e231-e242. doi: 10.5114/amsad.2019.89900.
14. Roberts DJ, Nagpal SK, Kubelik D, et al. Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study. BMJ, 2020, 371: m4104. doi: 10.1136/bmj.m4104.
15. Naser A, Isgandarov K, ?tal ?, et al. Peripheral neural blockade for pain control in patients undergoing percutaneous angioplasty for complex infrapopliteal disease. Turk Kardiyol Dern Ars, 2021, 49(4): 321-327.
16. Schroeder AR, Dehghan M, Newman TB, et al. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med, 2019, 179(2): 145-152.
17. Fereydooni A, O’Meara T, Popescu WM, et al. Utilization and outcomes of local anesthesia and peripheral nerve block for hybrid lower extremity revascularization. J Endovasc Ther, 2020, 27(1): 94-101.
18. Yazigi A, Madi-Gebara S, Haddad F, et al. Intraoperative myocardial ischemia in peripheral vascular surgery: general anesthesia vs combined sciatic and femoral nerve blocks. J Clin Anesth, 2005, 17(7): 499-503.
19. 中華醫學會外科學分會血管外科學組, 中國醫師協會血管外科醫師分會, 中國醫療保健國際交流促進會血管外科分會, 等. 中國慢性靜脈疾病診斷與治療指南. 中華醫學雜志, 2019, 99(39): 3047-3061.
20. 中國醫師協會血管外科醫師分會靜脈學組. 常見靜脈疾病診治規范(2022年版). 中華血管外科雜志, 2022, 7(1): 12-29.
21. Prochaska JH, Arnold N, Falcke A, et al. Chronic venous insufficiency, cardiovascular disease, and mortality: a population study. Eur Heart J, 2021, 42(40): 4157-4165.
22. Salim S, Machin M, Patterson BO, et al. Global epidemiology of chronic venous disease: A systematic review with pooled prevalence analysis. Ann Surg, 2021, 274(6): 971-976.
23. 中華醫學會麻醉學分會老年人麻醉與圍術期管理學組, 國家老年疾病臨床醫學研究中心, 國家老年麻醉聯盟. 中國老年患者圍手術期麻醉管理指導意見(2020版)(二). 中華醫學雜志, 2020, 100(33): 2565-2578.
24. Tran J, Chan VWS, Peng PWH, et al. Evaluation of the proximal adductor canal block injectate spread: a cadaveric study. Reg Anesth Pain Med, 2019, rapm-2019m-101091m. doi: 10.1136/rapm-2019-101091.
25. Tran DQ, Salinas FV, Benzon HT, et al. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med, 2019, rapm-2018-000019. doi: 10.1136/rapm-2018-000019.
26. 張文婷, 袁婉秋. 超聲引導下隱神經阻滯在大隱靜脈剝脫術中的效果觀察. 中國當代醫藥, 2021, 28(21): 149-151,155.
27. 孔祥云, 隋成, 周晶, 等. 股神經聯合坐骨神經阻滯麻醉在大隱靜脈曲張剝脫術中的臨床應用效果. 檢驗醫學與臨床, 2022, 19(14): 1992-1995.
28. Aherne TM, Ryan éJ, Boland MR, et al. Concomitant vs. staged treatment of varicose tributaries as an adjunct to endovenous ablation: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg, 2020, 60(3): 430-442.
29. De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology, 2014, 29(7): 428-441.
30. Wright TF, Brunetti GF, Kennedy P. Lidocaine safety after saphenous vein tumescent anesthesia. Phlebology, 2019, 34(10): 683-689.
31. Zhang YS, Chen PJ, Wan HL, et al. Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial. Phlebology, 2022, 37(7): 529-534.
32. Lomarat N, Akaraprasertkul J, Wongchompoo N, et al. Ultrasound-guided femoral block in patients undergoing radiofrequency ablation of incompetent saphenous veins: A randomized controlled trial. Asian J Surg, 2023, 46(1): 174-179.
33. Hurmerinta-Kurkij?rvi O, Weselius EM, Halmesm?ki K, et al. Femoral nerve blockade during endovenous laser ablation of great saphenous vein decreases pain but does not affect the use of opioids during the procedure. J Vasc Surg Venous Lymphat Disord, 2023, 11(5): 921-927.
34. Oh S, Kwon W. Quadratus lumborum block enables complete anesthesia for radiofrequency ablation in varicose vein surgery. J Clin Anesth, 2019, 56: 151-152.
35. 中國微循環學會周圍血管疾病專業委員會. 聚桂醇注射液治療下肢靜脈曲張微循環專家共識. 血管與腔內血管外科雜志, 2020, 6(5): 377-381.
36. de ávila Oliveira R, Riera R, Vasconcelos V, et al. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev, 2021, 12(12): CD001732. doi: 10.1002/14651858.CD001732.pub3.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress of perioperative pain management in patients with lower limb vascular diseases

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