title: Ropivacaine infusion in diabetics subject with peripheral arterial disease. A prospective study.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) predicts cardiovascular and cerebrovascular ischemic events. PAD treatment is aimed at reducing clinical symptoms, local tissue loss and at preventing complications.
  
  
  OBJECTIVE
  To evaluated the effect of peridural analgesia on peripheral perfusion and pain control.
  
  
  METHODS
  In 280 diabetic subjects with severe limb ischemia (65.7% males and 34.3% females, mean age 59.3±14.4 years) with a failure of medical treatment and contraindications to endovascular and/or surgical reperfusion, we performed a 30-day long peridural ropivacaine infusion, monitoring blood pressure, VAS and ABI periodically.
  
  
  RESULTS
  During ropivacaine infusion VAS significantly decreased (from 4.06±0.343 to 1.96±0.413, p<0.001). Furthermore, in the 261 (93.2%) subjects achieving a VAS value ≤2 during infusion, the effect was maintained after infusion withdrawing. ABI significantly improved both during infusion (from 0.30±0.04 at baseline to 0.65±0.05 at T30, p<0.001) and after infusion withdrawing as compared with baseline values.
  
  
  CONCLUSIONS
  30-day peridural analgesia with ropivacaine is a valuable therapeutic option in severe peripheral limb ischemia subjects with contraindication to surgery and with pharmacological therapy failure.
authors.affiliation: Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy. dario.diminno@hotmail.it
authors.forename: M N D
authors.initials: MN
authors.lastname: Di Minno
authors.forename: M
authors.initials: M
authors.lastname: Milone
authors.forename: A
authors.initials: A
authors.lastname: Russolillo
authors.forename: R
authors.initials: R
authors.lastname: Lupoli
authors.forename: A
authors.initials: A
authors.lastname: Di Minno
authors.forename: P
authors.initials: P
authors.lastname: Maietta
authors.forename: C
authors.initials: C
authors.lastname: Iacovazzo
authors.forename: G
authors.initials: G
authors.lastname: Salvatore
authors.forename: F
authors.initials: F
authors.lastname: Milone
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000517:prevention & control; D007511:Ischemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D000077212:Ropivacaine; D012720:Severity of Illness Index
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine