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Pharmacological pain management of critical limb ischaemia
  1. Tatsuma Sakaguchi and
  2. Toru Kajiyama
  1. Department of Palliative Care, Kitano Hospital, Osaka, Japan
  1. Correspondence to Dr Tatsuma Sakaguchi, Department of Palliative Care, Kitano Hospital, Osaka 530-8480, Japan; sakaguchi.tatsuma{at}

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The pharmacological management of pain secondary to critical limb ischaemia (CLI) is a challenging topic. Although surgical or local interventions, such as reconstructive vascular surgery, amputation, or nerve blocks, may relieve the pain, they are not immediately adaptable to all patients. However, to the best of our knowledge, there are no international or local guidelines on this subject. There also appears to be a paucity of surveys on the management of CLI in daily clinical practice. The authors of a recent systematic review included only six studies in their criteria.1 Previous studies focused on intravenous lidocaine, gabapentin, ketamine and a buprenorphine patch compared with morphine or placebo. There was substantial heterogeneity in quality and side effect profiles in these studies. Therefore, no recommendations of pharmacological agents could be made, although several approaches have shown positive results to manage pain in patients with CLI. In this study, we describe clinical data and our institutional policy in the pain management of CLI, and especially focus on fentanyl administration.

This was a retrospective observational study in a single, community hospital in Osaka, Japan. Patients who require reconstructive vascular surgery for CLI in our hospital are referred to a specialised centre of peripheral vascular surgery. Forty-two patients were diagnosed with CLI (32 patients (74%) were men; mean age: 78 years) in 3 years (between March 2019 and February 2022). Their characteristics are shown …

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  • Contributors Both authors contributed equally to the conception and design of the study, collection, analysis, and interpretation of the data, and drafting of the manuscript. All authors gave final approval of the manuscript for submission and publication and accept accountability for the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.