Ultrasound-Guided Sciatic Popliteal Nerve Block vs. Erector Spinae Plane Block in Endovascular Management of CLI

Ultrasound-Guided Sciatic Popliteal Nerve Block vs. Erector Spinae Plane Block in Patients Undergoing Endovascular Management of Critical Lower Limb Ischemia

Comparison of popliteal sciatic nerve block and erector spinae plane block (ESPB) in patients undergoing endovascular management of critical lower limb ischemia (CLI).

Nerve blocks, particularly regional anesthesia techniques, have been increasingly used in the endovascular management of critical lower limb ischemia (CLI). These techniques offer numerous advantages over general and local anesthesia.

Primary Advantages of Nerve Blocks:

1. Superior Pain Control

   Nerve blocks, such as femoral and sciatic nerve blocks, provide effective pain relief by anesthetizing the nerve supply to the lower limb.

   They offer more comprehensive analgesia than local anesthesia alone, as they numb the entire area around the puncture site.

2. Enhanced Patient Comfort

   Nerve blocks allow patients to remain pain-free during and after the procedure.

   They minimize discomfort even in lengthy or complex cases.

3. Reduction in Systemic Analgesic Requirements

   By providing localized anesthesia, nerve blocks significantly reduce the need for systemic analgesics, particularly opioids.

   This is essential because CLI patients often have comorbidities that make opioid use risky.

4. Fewer Opioid-Related Side Effects

   Nerve blocks reduce the incidence of opioid-related side effects, including nausea, vomiting, respiratory depression, and sedation.

5. Improved Hemodynamic Stability

Nerve blocks preserve autonomic nervous system function, reducing fluctuations in blood pressure and heart rate compared to general anesthesia.

This is especially beneficial for CLI patients, who frequently have underlying cardiovascular disease.

Inclusion Criteria:

1. Patient age will be 20-70 years.
2. Patients will be diagnosed with critical lower limb ischemia by clinical presentations and investigations.
3. ASA physical status 2-3

Exclusion Criteria:

1. Patient refusal to participate in this study.
2. Patient inability to understand the scales or to describe to the investigators.
3. Coagulation disorder.
4. Sever renal or kidney dysfunction.
5. Taking opioids before admission.
6. Morbid obesity .