#36337 Severe hand pain in iv-stage leriche-fontaine peripheral artery disease(pad): combination between regional anesthesia(RA) and ozone(O3) therapy for recovery of microcirculation. A case report

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Background and Aims

PAD induces severe and disabling pain with gradual functional impairment and progressive circulation disorder leading to gangrene. Affection of microcirculation rarely develops an effective compensatory mechanism and can’t be treated surgically. RA reduces pain and induces vasodilation, acting on sympathetic and sensitive nerve fibers. O3 therapy promotes nitric oxide release resulting in vasodilation, improves O2 delivery and activates mediators involved in endothelial regeneration. We hypothesized that the combination of RA and O3 could be effective for pain relief and reactivation of microcirculation.

Methods

We treated 1 male patient(68y), with a critical, bilateral upper extremities PAD not amenable to revascularization surgery and with severe pain(NRS=10), poor responsive to drugs. Signs of chronic ischemia, including gangrene, were present. The last chance treatment was the amputation of both hands. We performed autohemotherapy(30 ml of blood + 30 ml of O2O3 blend at 40 mcg/ml of concentration) twice a week + digital nerve block with levobupivacaine 0,15% + subcutaneous infiltration of O2O3 at 10 mcg/ml.

Results

Following one week of treatment pain disappeared completely. After 2 months hands were warmer and well-perfused, areas of dry necrosis were delimited, granulation tissue appeared and eschars fell off from healthier skin. Doppler showed arterial flows. No collateral effects occurred. Maintenance therapy was once a week for 2 months.

Conclusions

The combination between RA and O3 therapy has shown to be a safe and an effective conservative treatment in managing pain and in the reactivation of microcirculation in this severe case of PAD, avoiding demolitive amputation surgery of both hands.