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DOI: 10.1055/s-0032-1327757
Ropivacaine Infusion in Diabetics Subject with Peripheral Arterial Disease. A Prospective Study
Publication History
received 04 June 2012
first decision 05 October 2012
accepted 17 October 2012
Publication Date:
12 November 2012 (online)
Abstract
Background:
Peripheral arterial disease (PAD) predicts cardiovascular and cerebrovascular ischemic events. PAD treatment is aimed at reducing clinical symptoms, local tissue loss and at preventing complications.
Aims:To evaluated the effect of peridural analgesia on peripheral perfusion and pain control.
Methods:
In 280 diabetic subjects with severe limb ischemia (65.7% males and 34.3% females, mean age 59.3±14.4 years) with a failure of medical treatment and contraindications to endovascular and/or surgical reperfusion, we performed a 30-day long peridural ropivacaine infusion, monitoring blood pressure, VAS and ABI periodically.
Results:
During ropivacaine infusion VAS significantly decreased (from 4.06±0.343 to 1.96±0.413, p<0.001). Furthermore, in the 261 (93.2%) subjects achieving a VAS value≤2 during infusion, the effect was maintained after infusion withdrawing. ABI significantly improved both during infusion (from 0.30±0.04 at baseline to 0.65±0.05 at T30, p<0.001) and after infusion withdrawing as compared with baseline values.
Conclusions:
30-day peridural analgesia with ropivacaine is a valuable therapeutic option in severe peripheral limb ischemia subjects with contraindication to surgery and with pharmacological therapy failure.
** The 2 authors equally contributed to this study.
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References
- 1 Dormandy JA, Rutherford RB.. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31: S1-S296
- 2 Aquino R, Johnnides C, Makaroun M et al. Natural history of claudication: long-term serial follow-up study of 1244 claudicants. J Vasc Surg 2001; 34: 962-970
- 3 Ebskov L, Schroeder T, Holstein P. Epidemiology of leg amputation: the influence of vascular surgery. Br J Surg 1994; 8: 1600-1603
- 4 Bendermacher BLW, Willigendael EM, Teijink JAW et al. Medical management of peripheral arterial disease. J Thromb Haemost 2005; 3: 1628-1637
- 5 Slovut DP, Sullivan TM. Critical limb ischemia: medical and surgical management. Vasc Med 2008; 13: 281-291
- 6 Protsenko NV, Strelets BM, Petin GI. Vestn Khir. The characteristics of epidural anesthesia in operations on the aorta and vessels of the lower extremities. Vestn Khir Im I I Grek 1991; 146: 80-83
- 7 Markham A, Faulds D. Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs 1996; 52: 429-449
- 8 Hirsch AT, Haskal ZJ, Hertzer NR et al. American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006 113. e463-e654
- 9 Halperin JL. Evaluation of patients with peripheral vascular disease. Thromb Res 2002; 106: V303-V311
- 10 Santilli JD, Santilli SM. Chronic critical limb ischemia: diagnosis, treatment and prognosis. Am Fam Physician 1999; 59: 1899-1908