Prophylactic Regenerative Peripheral Nerve Interface Surgery in Pediatric Lower Limb Amputation Patients

To evaluate the prophylactic effect of regenerative peripheral nerve interface (RPNI) surgery on pediatric postamputation pain.

Chronic postamputation pain is a debilitating and refractory sequela of limb amputation affecting up to 83% of pediatric patients with limb loss, resulting in disability and decreased quality of life. We postulate that prophylactic RPNI surgery performed during amputation may decrease the incidence of symptomatic neuroma and development of phantom limb pain, as well as limit analgesic use among pediatric patients with limb loss.

Retrospective chart review was performed on pediatric patients between the ages of 8 and 21 years who underwent major lower limb amputation with and without RPNI surgery. Documented neuroma and phantom limb pain scores, as well as analgesic use, were recorded. Narcotic use was converted to milligrams morphine equivalents per day, whereas overall analgesic use was converted to Medication Quantification Scale version III scores. Analysis was performed using Stata.

Forty-four pediatric patients were identified; 25 RPNI patients and 19 controls. Of control patients, 79% developed chronic postamputation pain versus 21% of RPNI patients ( P < 0.001). Among the patients who developed postamputation pain, 20% of controls developed clinical neuroma pain, compared with 0% of RPNI patients ( P < 0.001). In addition, RPNI patients demonstrated a significant decrease in pain score ( P = 0.007) and narcotic usage ( P < 0.01) compared with controls. Overall analgesic use did not vary significantly between groups.

Prophylactic RPNI surgery shows promise for pediatric patients undergoing major lower limb amputation by preventing both symptomatic neuromas and possibly the development of phantom limb pain.