title: Continuous regional anaesthesia provides effective pain management and reduces opioid requirement following major lower limb amputation.
abstract: OBJECTIVE
  Postoperative stump pain after major lower limb amputation is a significant impediment to the recovery of amputees. The vast majority of patients require opioid analgesics following surgery, which are associated with opioid-related side-effects. Here, we investigate whether intraoperative placement of a peripheral nerve stump catheter followed by continuous infusion of local anesthetic is as effective at pain control as current analgesic practices. If beneficial, this procedure could potentially reduce post-amputation opioid consumption and opioid-related adverse effects.
  
  
  METHODS
  A retrospective chart review was conducted of 198 patients over a 4-year period who had undergone a major lower limb amputation for indications related to peripheral vascular disease. Postoperatively, 102 patients received a perineural catheter were compared to 96 patients who did not. The primary outcomes of this study were the amount of morphine equivalents used in the first 72 hours postoperatively and postoperative pain intensity in the first 24 hours.
  
  
  RESULTS
  A total of 198 lower-limb amputations were selected for analyses. Multiple regression analyses indicated that perineural catheter use was associated with a lower cumulative postoperative opioid consumption over the first 72 hours but not postoperative pain scores at 24 hours. Perineural catheter use led to a 40% reduction in opioid use during the first 72 hours postoperatively. Mixed model repeated measures analysis demonstrated that this opioid reduction was consistent over time. Other variables related to total opioid use included age, pre-surgical chronic pain, pre-surgical opioid use, patient-controlled analgesia.
  
  
  CONCLUSIONS
  Continuous perineural infusions of local anesthetic are a safe and effective method for reducing post-amputation opioid analgesic medications after major lower limp amputation.
authors.affiliation: Division of Vascular Surgery, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: O G S
authors.initials: OG
authors.lastname: Ayling
authors.affiliation: Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Montbriand
authors.affiliation: Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ladak
authors.affiliation: Division of Vascular Surgery, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Love
authors.affiliation: Division of Vascular Surgery, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Eisenberg
authors.affiliation: Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Clarke
authors.affiliation: Division of Vascular Surgery, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: graham.roche-nagle@uhn.ca.
authors.forename: G
authors.initials: G
authors.lastname: Roche-Nagle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local
keywords: Amputation; Analgesics; Opioid; Perineural catheter