IR-led popliteal nerve blocks - a game changer in CLTI management

Popliteal nerve blocks are a type of regional nerve block undertaken with ultrasound guidance.  The educational exhibit aims to describe the technique and how it can be introduced safely into the department, under interventional radiology-led practice. Tips for performing procedure and staff training will be highlighted.

Background:

Patients with acute limb ischaemia or chronic limb-threatening ischaemia (CLTI) can suffer considerable pain.  This can sometimes necessitate general anaesthesia, or systemic analgesia with sedation.  It can become particularly problematic when the patients must lie flat, sometimes for a considerable length of time for a challenging endovascular procedures. An alternative option is to perform a regional nerve block (e.g. femoral or popliteal).  This exhibit describes the introduction of an IR-led popliteal nerve block service and the benefits this brings to patients.

Clinical Findings/Procedure Details:

We retrospectively reviewed the first 50 cases of performing popliteal nerve in our department.  This including mentoring and supervision of interventional radiologists to gain competence with help from anaesthetic colleagues.  Also broader training of the supporting nursing staff to gain familiarity with the technique.  Pain severity was assessed on a visual analogue scale and use of additional analgesia or sedation was recorded.  No serious complications were encountered.

Conclusion and/or Teaching Points:

Pain scores were dramatically reduced following nerve block.  Doses of additional analgesia or need for sedation was also greatly diminished.  Obtaining better pain control can be a true ‘game changer’ for some patients, enabling a successful interventional procedure.  There is also a theoretical vasodilatory benefit, which may be of benefit to patients undergoing crural angioplasty.  The procedure can be safely performed as an IR-led procedure with low complication rates.