A novel bFGF-GH injection therapy for two patients with severe ischemic limb pain

• Published in: Journal of anesthesia Vol. 22; no. 4; pp. 449 - 452
• Main Authors: Ito, Naomi, Saito, Shigeru, Yamada, Makiko Hardy, Koizuka, Shiro, Obata, Hideaki, Nishikawa, Koichi, Tabata, Yasuhiko
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 2008
• Subjects: Adult; Aged, 80 and over; Anesthesiology; Arteriosclerosis Obliterans - complications; Arteriosclerosis Obliterans - drug therapy; Clinical Report; Critical Care Medicine; Emergency Medicine; Extremities - blood supply; Fibroblast Growth Factor 2 - administration & dosage; Fibroblast Growth Factor 2 - adverse effects; Fibroblast Growth Factor 2 - therapeutic use; Foot Ulcer - complications; Growth Hormone - administration & dosage; Growth Hormone - adverse effects; Growth Hormone - therapeutic use; Humans; Intensive; Ischemia - complications; Male; Medicine; Medicine & Public Health; Pain - drug therapy; Pain - etiology; Pain Measurement; Pain Medicine; Pain, Intractable - drug therapy; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Regional Blood Flow; Sympathectomy; Autonomic nerve block; Angiogenesis; Peripheral vascular disorder; Ischemic pain
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-008-0649-8

Severe ischemic pain is difficult to treat with a single therapy. Although modern angiogenic therapies have been used in patients with peripheral arterial occlusive diseases, a regimen combining novel angiogenic therapy and classic nerve blocks, including sympathectomy, has not been discussed to date. In this case report, we present two patients with peripheral arterial occlusive disease who were first treated with medication and lumbar sympathectomy, and then with a novel gelatin hydrogel drug-delivery system loaded with basic fibroblast growth factor. The gelatin hydrogel combined with recombinant basic fibroblast growth factor was injected intramuscularly into the ischemic limbs. In the first patient, with arteriosclerosis obliterans, a foot ulcer was healed, and the original score for resting pain (visual analogue scale, 5/10) was decreased to 0/10. In the second patient, with Buerger’s disease, a large toe ulcer was healed, and his resting pain (visual analogue scale, 8/10) was decreased to 1/10. Some other parameters, such as skin surface temperature, transcutaneous oxygen partial pressure, and pain-free walking distance, were also improved in both patients after the combined therapy. A multimodal approach is necessary to treat severe ischemic pain. Novel angiogenic therapy combined with nerve blocks seems to be a promising option in patients with severe pain.