Ultrasound-Guided Subgluteal Sciatic Nerve Block for Pain Management during Endovascular Treatment for Below-the-Knee Arterial Occlusions.

PURPOSE To evaluate the pain control of subgluteal sciatic nerve block (SSNB) in the endovascular treatment of below-the-knee (BTK) occlusions. MATERIALS AND METHODS This randomized prospective controlled study evaluated 60 consecutive adult patients who underwent endovascular treatment for BTK occlusions. The patients were randomized into two equal groups: the SSNB group underwent SSNB in the subgluteal space under ultrasound guidance, while the control group received fentanyl as an analgesic. The visual analog scale (VAS) and Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were recorded. RESULTS Compared with the control group, the SSNB group showed significantly lower median VAS score (0 [range 0-30] vs 70 [range 20-100], p<0.001) and median FLACC score (0 [range 0-2] vs 6 [range 3-10], p<0.001). There was no statistical difference between the two groups regarding remaining parameters. There was a very strong correlation between the VAS and FLACC scores in both the SSNB group (r=0.805, p<0.001) and the control group (r=0.950, p<0.001). Operation time and total balloon inflation time were correlated with the VAS (r=0.411, p=0.024 and r=0.402, p=0.031, respectively) and FLACC (r=0.431, p=0.017 and r=0.414, p=0.022, respectively) scores in the control group, but not in the SSNB group (r=0. 364, p=0.056 and r=0.300, p=0.085, respectively, for correlation with VAS score and r=0.730, p=0.068 and r=0.704, p=0.075, respectively, for correlation with the FLACC score). CONCLUSION SSNB is a highly effective and safe pain management modality in the endovascular treatment of BTK occlusions.