The Journal of Practical Medicine >

2024 , Vol. 40 >Issue 11: 1531 - 1536

DOI: https://doi.org/10.3969/j.issn.1006-5725.2024.11.011

Clinical Research

Effect of ultrasound-guided iliac fascia combined with sciatic nerve block on major cardiovascular adverse events in patients undergoing lower limb revascularization surgery

  • Manman LIU ,
  • Wanxia XIONG ,
  • Meijing YING ,
  • Chao LIANG ,
  • Ming. DING
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  • *.Department of Anesthesiology，Zhongshan Hospital，Fudan University（Xiamen Branch），Xiamen 361000，China

Received date: 2024-01-15

  Online published: 2024-06-13

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Abstract

Objective To assess the impact of ultrasound-guided fascia iliaca compartment block on major cardiovascular events and postoperative prognosis in patients with lower limb aortoiliac occlusive disease （ASO）. Methods This study was a retrospective study including 353 patients with lower limb arterial reconstruction surgery for ASO at Xiamen Hospital Affiliated to Zhongshan Hospital of Fudan University from January 2018 to January 2022. Patients were divided into two groups based on different anesthesia： the group receiving ultrasound-guided fascia iliaca block combined with sciatic nerve block （Group B） and the group receiving monitored anesthesia care （MAC） （Group M）. The primary outcome was the occurrence of major adverse cardiovascular events after lower limb arterial reconstruction surgery in ASO patients. The secondary outcomes included the incidence of non-cardiac postoperative myocardial injury， postoperative amputation， and other adverse reactions such as postoperative delirium， nausea， and vomiting as well as postoperative laboratory indicators. By using propensity score matching to balance baseline characteristics before surgery， the impact of different anesthesia methods on the occurrence of MACE and prognosis after surgery in ASO patients was analyzed. Results After propensity score matching， the incidence of MACE in Group B was lower compared with Group M （10% vs. 3.4%， P = 0.038）； The incidence of MINS in Group B （33% vs. 25%， P = 0.200）； The amputation rate of Group B （4.2% vs. 3.4%， P > 0.99）； The incidence of complications in Group B was （6.8% vs. 4.2%， P = 0.39）； There was no statistically significant difference in postoperative laboratory indicators between the two groups （P > 0.05）. Multivariate analysis showed that nerve block （OR = 0.25， 95%CI：0.05 ~ 0.93）， postoperative HBG （OR = 0.95， 95%CI：0.91 ~ 0.99） were independent factors in reducing the incidence of MACE. Conclusion Ultrasound-guidance fascia iliaca compartment block and sciatic nerve block could reduce the risk of major adverse cardiovascular events in patients undergoing lower limb arterial revascularization surgery.

Key words： fascia iliaca; sciatic nerve block; major cardiovascular adverse events; propensity score matching

Cite this article

Manman LIU , Wanxia XIONG , Meijing YING , Chao LIANG , Ming. DING . Effect of ultrasound-guided iliac fascia combined with sciatic nerve block on major cardiovascular adverse events in patients undergoing lower limb revascularization surgery[J]. The Journal of Practical Medicine, 2024 , 40(11) : 1531 -1536 . DOI: 10.3969/j.issn.1006-5725.2024.11.011

References

1 CREAGER M A， MATSUSHITA K， ARYA S， et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030： time to get to our feet： a policy statement from the american heart association［J］. Circulation， 2021， 143（17）： e875?e891. doi:10.1161/cir.0000000000000967
2 CRIQUI M H， MATSUSHITA K， ABOYANS V， et al. Lower extremity peripheral artery disease： contemporary epidemiology， management gaps， and future directions： a scientific statement from the american heart association［J］. Circulation， 2021， 144（9）： e171?e191. doi:10.1161/cir.0000000000001019
3 BIEROWSKI M， GALANIS T， MAJEED A， et al. Peripheral artery disease： overview of diagnosis and medical therapy［J］. Med Clin North Am， 2023， 107（5）： 807?822. doi:10.1016/j.mcna.2023.05.007
4 SONG P， RUDAN D， ZHU Y， et al. Global， regional， and national prevalence and risk factors for peripheral artery disease in 2015： an updated systematic review and analysis［J］. Lancet Glob Health，2019，7（8）： e1020?e1030. doi:10.1016/s2214-109x(19)30255-4
5 SMILOWITZ N R， BERGER J S. Perioperative cardiovascular risk assessment and management for noncardiac surgery： a review［J］. JAMA， 2020， 324（3）： 279?290. doi:10.1001/jama.2020.7840
6 STRICKLAND S S， QUINTELA E M， WILSON M J， et al. Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery： meta-analysis［J］. BJS Open， 2023， 7（2）： zrad021. doi:10.1093/bjsopen/zrad021
7 VAN LIER F， WESDORP F H I M， LIEM V G B， et al. Association between postoperative mean arterial blood pressure and myocardial injury after noncardiac surgery［J］. Br J Anaesth， 2018，120（1）： 77?83. doi:10.1016/j.bja.2017.11.002
8 BICCARD B M， SCOTT D J A， CHAN M T V， et al. Myocardial injury after noncardiac surgery （mins） in vascular surgical patients： a prospective observational cohort study［J］. Ann Surg， 2018， 268（2）： 357. doi:10.1097/sla.0000000000002290
9 HARKY A， AHMAD M U， SANTORO G， et al. Local versus general anesthesia in nonemergency endovascular abdominal aortic aneurysm repair： a systematic review and meta-analysis［J］. J Cardiothorac Vasc Anesth， 2020， 34（4）： 1051?1059. doi:10.1053/j.jvca.2019.07.007
10 FEREYDOONI A， O′MEARA T， POPESCU W M， et al. Utilization and outcomes of local anesthesia and peripheral nerve block for hybrid lower extremity revascularization［J］. J Endovasc Ther， 2020， 27（1）： 94?101. doi:10.1177/1526602819887382
11 MARSAL J R， URRETA-BARALLOBRE I， UBEDA-CARRIL?LO M， et al. Sample size requirement in trials that use the composite endpoint major adverse cardiovascular events （mace）： new insights［J］. Trials， 2022， 23（1）： 1037. doi:10.1186/s13063-022-06977-4
12 DEVEREAUX P J， SZCZEKLIK W. Myocardial injury after non-cardiac surgery： diagnosis and management［J］. Eur Heart J， 2020， 41（32）： 3083?3091. doi:10.1093/eurheartj/ehz301
13 SZCZEKLIK W， KRZANOWSKI M， MAGA P， et al. Myocardial injury after endovascular revascularization in critical limb ischemia predicts 1-year mortality： a prospective observational cohort study［J］. Clin Res Cardiol， 2018， 107（4）： 319?328. doi:10.1007/s00392-017-1185-z
14 PERLAS A， CHAN V W S， BEATTIE S. Anesthesia technique and mortality after total hip or knee arthroplasty： a retrospective， propensity score-matched cohort study［J］. Anesthesiology， 2016， 125（4）： 724?731. doi:10.1097/aln.0000000000001248
15 LIM J A， SEO Y， CHOI E J， et al. Impact of regional anesthesia on outcomes of geriatric patients undergoing lower extremity revascularization： a propensity score-matched cohort study［J］. Medicine， 2022， 101（52）： e32597. doi:10.1097/md.0000000000032597
16 ROBERTS D J， NAGPAL S K， KUBELIK D， et al. Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes： population based comparative effectiveness study［J］. BMJ， 2020， 371： m4104. doi:10.1136/bmj.m4104
17 REYNOLDS C A， MINIC Z. Chronic pain-associated cardiovascular disease： the role of sympathetic nerve activity［J］. Int J Mol Sci， 2023， 24（6）： 5378. doi:10.3390/ijms24065378
18 陈玲，胡阳，王煜，等. 远程缺血预处理-减轻心肌再灌注损伤的机制 ［J］. 实用医学杂志， 2021， 37 （1）： 121-124. doi:10.3969/j.issn.1006-5725.2021.01.025
19 LU B， JIANG J， LI X， et al. Original research： regional haemodynamic variables and perfusion index in the evaluation of sciatic nerve block： a prospective observational trial［J］. BMJ Open，2022，12（5）：e057283. doi:10.1136/bmjopen-2021-057283
20 KUS A， GURKAN Y， GORMUS S K， et al. Usefulness of perfusion index to detect the effect of brachial plexus block［J］. J Clin Monit Comput， 2013， 27（3）： 325?328. doi:10.1007/s10877-013-9439-4
21 SZCZEKLIK W， KRZANOWSKI M， MAGA P， et al. Myocardial injury after endovascular revascularization in critical limb ischemia predicts 1-year mortality： a prospective observational cohort study［J］. Clin Res Cardiol， 2018，107（4）： 319?328. doi:10.1007/s00392-017-1185-z
22 BAERISWYL M， TAFFé P， KIRKHAM K R， et al. Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy： a prospective cohort study［J］. Anaesthesia， 2018， 73（9）： 1110?1117. doi:10.1111/anae.14347
23 CUVILLON P， REUBRECHT V， ZORIC L， et al. Comparison of subgluteal sciatic nerve block duration in type 2 diabetic and non-diabetic patients［J］. Br J Anaesth， 2013， 110（5）： 823?830. doi:10.1093/bja/aes496
24 BICCARD B M， SCOTT D J A， CHAN M T V， et al. Myocardial injury after noncardiac surgery （mins） in vascular surgical patients： a prospective observational cohort study［J］. Ann Surg， 2018， 268（2）： 357. doi:10.1097/sla.0000000000002290
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