Pain Management in Peripheral Artery Diseases
Özet
This text comprehensively discusses pain management in patients suffering from peripheral artery disease (PAD), a vascular condition characterized by the narrowing and occlusion of the arterial system that causes intense walking and rest pain. To improve patient comfort and prevent severe complications, treatment begins with a step-ladder approach determined by pain severity. For mild to moderate pain, pharmacological treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or weak opioids like tramadol, while neuropathic pain is managed using antidepressants or antiepileptics like gabapentin and pregabalin. Severe pain necessitates potent opioids such as morphine or fentanyl, and cilostazol can be administered to reduce claudication pain through arterial vasodilation. Furthermore, regional anesthesia techniques offer significant perioperative benefits. These include peripheral nerve blocks for the upper and lower extremities—such as brachial plexus, femoral, adductor canal, and sciatic nerve blocks—usually performed under ultrasound guidance to optimize success. Central neuraxial blocks, including spinal, epidural, and combined spinal-epidural anesthesia, provide effective alternative options, frequently utilizing patient-controlled epidural analgesia (PCEA) to achieve optimal pain relief while minimizing motor blockade.
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