Continuous postoperative regional analgesia by nerve sheath block for amputation surgery--a pilot study

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Procedures

Background:

• Postoperative pain management after lower limb amputation presents challenges.
• Phantom limb pain (PLP) is a common and debilitating complication.
• Current analgesic strategies may have limitations in efficacy and side effects.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous postoperative regional analgesia via nerve sheath block for lower limb amputation.
• To assess the impact of this technique on narcotic analgesic requirements.
• To investigate the incidence of phantom limb pain following the intervention.

Main Methods:

• A pilot study involving 11 patients undergoing lower limb amputation (ASA III-IV).
• Catheters were placed in the nerve sheath of transected sciatic or posterior tibial nerves.
• Continuous infusion of 0.25% bupivacaine (10 mL/h) for 72 hours postoperatively.

Main Results:

• Effective amputation stump analgesia was achieved.
• Significantly reduced need for on-demand narcotic analgesics (mean 1.4 mg morphine equivalent vs. 18.4 mg in controls, P < 0.0001).
• No technique-related complications were observed. Follow-up up to 12 months showed absence of phantom pain.

Conclusions:

• Continuous postoperative regional analgesia by nerve sheath block is a safe and effective method for managing lower limb amputation pain.
• This technique substantially decreases opioid requirements in the early postoperative period.
• Nerve sheath block may prevent the development of phantom limb pain, even in patients with pre-existing limb pain.