Sympathectomy with radiofrequency ablation or chemical sympathectomy is reported to be effective for severe refractory ischemic pain. Reduction in pain, increased sleep, and low incidence of side effects have been reported with transdermal buprenorphine plus epidural (or intrathecal) infusion of morphine with ropivacaine or bupivacaine. Peripheral nerve block (PNB) with inpatients with chronic ischemic lower extremity pain showed that continuous PNB is an effective, safe, and comfortable modality for long-term use in the home setting for patients with intractable chronic pain.
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