Combined Fascia Iliaca Compartment-Sciatic Nerve Blocks Reduce Early Cardiovascular Events in Chronic Limb-Threatening Ischemia: A Propensity Score-Matched Retrospective Study.

OBJECTIVE

To compare postoperative outcomes between combined fascia iliaca compartment-sciatic nerve blockade (FICB-SNB) and monitored anesthesia care (MAC) in patients with chronic limb-threatening ischemia (CLTI) undergoing lower-extremity revascularization (LER).

DESIGN

Retrospective matched cohort study (1:1 propensity score matching).

SETTING

Single-center analysis of CLTI patients undergoing LER.

PARTICIPANTS

216 matched pairs (total n = 432) selected from 505 eligible patients.

INTERVENTIONS: FICB-SNB (n = 216) versus MAC (n= 216).

MEASUREMENTS & MAIN

RESULTS

Primary outcomes: Compared to MAC, FICB-SNB did not significantly reduce in-hospital major adverse cardiovascular events (MACE) (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.18-1.32; p = 0.15) or 1-year MACE (p > 0.05).

SECONDARY OUTCOMES: FICB-SNB demonstrated superior postoperative analgesia, reducing rest pain by 67% (OR, 0.33; 95% CI, 0.23-0.48; p < 0.001). No differences were observed in myocardial injury after noncardiac surgery, complications, or amputation rates (p > 0.05 for all).

CONCLUSIONS

FICB-SNB improves analgesia but does not significantly reduce short- or long-term MACE. The trend toward lower in-hospital MACE suggests transient intraoperative cardiovascular stabilization not sustained at 1 year. A prospective randomized trial with standardized protocols to control confounders and validate clinical trends is warranted.