Verapamil-bupivacaine versus morphne-bupivacaine for sympathetic block and pain treatment in peripheral occlusive vascular disease

Introduction. Pain accompanying peripheral occlusive vascular disease (POVD; has been previously treated with morphine and local anesthetics (1. 2) The efficacy of systemic administration of verapamil in POVD has been shown (3) Its use as an adjunct to pain treatment in has also been studied (4) In this study we compared the analgesic efficacy of morphine and verapamil in patients with POVD in order to determine if verapamil can also be used as an adjunct to lumbar sympathetic block obtained with bupivacaine Methods IARB approval and patient consent was obtained for the study 24 patients Fontaine stages III and IV unsuitable for arterial reconstruction were randomly allocated to two groups All patients had epidural catheters implanted at L 2-3 or L3-4 level and subcutaneously tunneled Bupivacaine 6 mL 0 375% every 8 hrs (8:00, 16:00, 24:00 hrs) was the standard baseline treatment regimen in both groups, Group M (n=12) received morphine 2 mg at 8:00 and 24:00 hrs and Group V(n=12) received verapamil 2.5 mg twice epidurally at the same time intervals in addition to bupivacaine. Mean duration of analgesia, VAS scores and satisfaction scores (5 point scale), additional analgesic requirement, side effects were recorded in both groups. Results: Groups were similar in terms of demographic data, mean age in group M was 54±11 and in group V 51±8 Duration of the treatment was 12±3 and 15r4 days in groups M and V respectively. Mean VAS score in group M during treatment was 3.2±1 3 and in group V 3.2±1.0 (p>0.05). Mean satisfaction score was 3.4 ±0.6 and 3.4⁺0.5 in groups M and V respectively (p>0.05) Additional analgesic requirement (pethidine 50 mg im) was similar in both groups. Pruritus was the only side effect recorded (2 patients group M). No side effect attributable to treatment with verapamil was noted. Discussion: Although more complex treatment modalities such as spinal cord stimulation have been advocated for POVD in the last decade, the role of effective sympathetic blockade still requires extensive evaluation (5). In this study the efficacy of epidurally administered verapamil as an adjunct to bupivacaine in pain treatment has been shown. It may be used as an alternative to low dose morphine when deemed necessary in patients with POVD.