Peripheral Nerve Block for Carbon Dioxide Angiography in Below-the-Knee Interventions: Impact on Pain Control, Image Quality, and Procedural Efficiency.

PURPOSE: To evaluate the efficacy and safety of combined popliteal sciatic and femoral nerve blocks and their impact on image quality during carbon dioxide (CO2) angiography.

MATERIALS AND

METHODS

This retrospective study evaluated patients undergoing CO2 angiography who received either moderate sedoanalgesia or combined popliteal sciatic and femoral nerve block. Intra-procedural pain was assessed using the visual analog scale (VAS), and image quality, procedural parameters, and patient and operator satisfaction were compared between groups. A 1:1 propensity score matching (PSM) analysis was performed to reduce baseline confounding.

RESULTS

Among 103 patients (nerve block, n=45; sedoanalgesia, n=58), VAS scores were lower in the nerve block group (0 [0-2] vs. 5 [3-8], p <0.001). Procedure duration (89.7±47.3 vs. 124.2±44.5 min), fluoroscopy time (28.6±19.9 vs. 42.0±16.8 min), fluoroscopy exposures (12.8±5.1 vs. 19.4±8.1), radiation dose (342.9 [100-1733] vs. 448.4 [130-3199] mGy), and iodinated contrast volume (4 [3-8] vs. 19 [8-40] mL) were lower in the nerve block group (all p <0.001). Patient and operator satisfaction and image quality were also improved (all p <0.001). After PSM, 29 matched pairs were analyzed; differences in VAS scores, image quality, contrast use, procedure duration, fluoroscopy time, and exposures remained significant, whereas radiation dose was comparable between groups.

CONCLUSION

Combined popliteal sciatic and femoral nerve blocks appear to be a safe and effective analgesic strategy for CO2 angiography and may improve both image quality and procedural efficiency compared with moderate sedoanalgesia.

LEVEL OF EVIDENCE: Level 3.