Comparison of epidural and popliteal blok in the treatment of procedural pain during debridement of ischemic foot ulcer

Introduction: Analgesics given for tretaing chronic ischamic pain may not be sufficient to treat procedural pain during foot debridement. As ulcer is localized to lower extremity, regional anesthesia is seemed to be possible to control pain during foot debridement. In this trial, the efficacy and safety of epidural and popliteal blok in the treatment of procedural pain during debridement of ischemic foot was compared. Material and Method: Thirty patients between 18-76 years age with foot ulcer due to peripheral vascular disease undergoing debridement were enrolled. Patients were allocated to two groups: to first group patients, epidural catheter (L ₁-L ₃ intervertebral space) and to second group patients popliteal catether (with posterior approaches) was introduced for reduce procedural pain. After injection 10 mL of lidocaine 2 % from epidural catheter and 20 mL of lidocaine 2 % from popliteal catheter, sensorial and motor blok were determined and all patients were sent to Cardio-Vascular-Thoracic Surgery Clinic for debridement. Mean arterial pressure measurements, visual analog scale (VAS) and patients satisfaction from procedures were assessed before and after the blocks and during the debridement. Results: Mean VAS during debridement between groups were statistically significantly low in popliteal group patients compared with epidural patients (p=0,001). Patients satisfaction measured with Likert' scale was higher in popliteal group patients (6.42±0; 50 % good) than epidural group (5.26±0.46; 25 % fairly good) (p=0.001). Mean arterial pressure in epidural patients group before and after the procedure was statistically different (p=0.001). Conclusion: Popliteal block was effective, long in duration and safe in the treatment of pain in patients with fool ulcer due to peripheral vascular disease during debridement.