Retrospective evaluation of the effect of lumbar sympathetic blockade on perfusion, fontaine classification and pain scales in peripheral artery patients

Objective: The aim of this study is to retrospectively evaluate the effect of lumbar sympathetic blockade on the patient's Fontaine Classification stage, pain scales and perfusion of the lower limb in patients with peripheral arterial disease of the lower extremities where revascularization is not possible in Çukurova University Algology Deparment. Material and methods: After the approval of the Ethics Committee of our faculty, a total of 21 patients who underwent lumbar sympathetic blockade between January 2020 and March 2021 were included in the study. The records containing the clinical information of these patients and the patient follow-up forms for six-month period were reviewed retrospectively. Stages of the patients according to the Fontaine Classification, Numeric Rating Scale (NRS), Pain Detect Questionnaire (PDQ) scores, and lower extremity arterial color Doppler Ultrasound (US) results were recorded before the procedure and at the1, 3, and 6 months after the procedure. The recorded data were statistically analyzed through SPSS 20.0 program (IBM Corp. Armonk, New York, USA). Results: Twenty one patients (17 male [% 81]) were statistically investigated in our study. Patients median age was 61 years old (min-max:41-86). The patient datas analyzed before procedure and one, three and six months after procedure according to the Fontaine Classification, Numeric Rating Scale (NRS) and Pain Detect Questionnaire (PDQ) scores. When compared with the baseline stages, it was determined that the Fontaine stages in the control follow-ups showed statistically significant regression over time (p < 0,001). The baseline NRS and PDQ scores of the patients before the procedure were compared with the NRS and PDQ scores of the first, third and sixth months after the procedure, and the decrease in NRS and PDQ scores after the procedure was statistically significant (p < 0.001). The baseline Doppler US evaluations before the procedure and the 1, 3. and 6. months evaluations of patients were analyzed comparatively, improvement in collateral circulation and development of new collateralization over time were found to be statistically significant (p < 0,001). Conclusion: The lumbar sympathetic blockade with local anesthetics and steroids used in the treatment of pain in patients with chronic extremity threatening ischemia in whom revascularization is not possible is a safe method due to its low complication rate and short hospitalization time. At the same time, due to decrease in NRS and PDQ scores, regression in Fontaine stages, and improvement in collateralization and new collateralization in Doppler US examination this treatment method considered as an effective treatment method. Keywords: Lomber sympathetic block, Fontaine Classification, Numeric Rating Scale (NRS), Pain Detect Questionnaire (PDQ), Doppler US.