#36337 Severe hand pain in iv-stage leriche-fontaine peripheral artery disease(pad): combination between regional anesthesia(RA) and ozone(O3) therapy for recovery of microcirculation. A case report

Marco Mazzocchi, Benedetta Mascia, Eleonora Pariani, Giacomo Bruschi, Pietro Quaretti, Alessandro Locatelli
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Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims

PAD induces severe and disabling pain with gradual functional impairment and progressive circulation disorder leading to gangrene. Affection of microcirculation rarely develops an effective compensatory mechanism and can’t be treated surgically. RA reduces pain and induces vasodilation, acting on sympathetic and sensitive nerve fibers. O3 therapy promotes nitric oxide release resulting in vasodilation, improves O2 delivery and activates mediators involved in endothelial regeneration. We hypothesized that the combination of RA and O3 could be effective for pain relief and reactivation of microcirculation.

Methods

We treated 1 male patient(68y), with a critical, bilateral upper extremities PAD not amenable to revascularization surgery and with severe pain(NRS=10), poor responsive to drugs. Signs of chronic ischemia, including gangrene, were present. The last chance treatment was the amputation of both hands. We performed autohemotherapy(30 ml of blood + 30 ml of O2O3 blend at 40 mcg/ml of concentration) twice a week + digital nerve block with levobupivacaine 0,15% + subcutaneous infiltration of O2O3 at 10 mcg/ml.

Results

Following one week of treatment pain disappeared completely. After 2 months hands were warmer and well-perfused, areas of dry necrosis were delimited, granulation tissue appeared and eschars fell off from healthier skin. Doppler showed arterial flows. No collateral effects occurred. Maintenance therapy was once a week for 2 months.

Conclusions

The combination between RA and O3 therapy has shown to be a safe and an effective conservative treatment in managing pain and in the reactivation of microcirculation in this severe case of PAD, avoiding demolitive amputation surgery of both hands.
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#36337严重的手部疼痛在iv期lerich -fontaine外周动脉疾病(pad):结合区域麻醉(RA)和臭氧(O3)治疗微循环恢复。病例报告
摘要奖项:我以麻醉师身份申请(年龄在35岁以下)背景和目的PAD引起严重的致残性疼痛,伴有逐渐的功能损害和进行性循环障碍,导致坏疽。微循环障碍很少形成有效的代偿机制,不能通过手术治疗。类风湿性关节炎通过作用于交感神经和敏感神经纤维,减轻疼痛并诱导血管舒张。O3治疗促进一氧化氮释放,导致血管舒张,改善O2输送,激活参与内皮再生的介质。我们假设RA和O3联合使用可以有效缓解疼痛和重新激活微循环。方法治疗1例男性患者(68岁),双侧上肢PAD危重,不能行血运重建术,疼痛严重(NRS=10),对药物反应较差。存在慢性缺血的迹象,包括坏疽。最后的治疗方法是截肢。我们每周进行两次自体血液治疗(30ml血液+ 30ml浓度为40mcg /ml的O2O3混合物)+左布比卡因0.15%的指神经阻滞+ 10mcg /ml的O2O3皮下浸润。结果治疗1周后疼痛完全消失。2个月后,手变暖,血流灌注良好,干坏死区被划定,肉芽组织出现,痂从健康皮肤脱落。多普勒显示动脉血流。没有发生任何附带影响。维持治疗每周一次,持续2个月。结论RA联合O3治疗是一种安全有效的保守治疗方法,可有效控制严重PAD患者的疼痛和微循环的恢复,避免了双手的破坏性截肢手术。
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