EFFECTIVENESS OF INTRAOPERATIVE PLACEMENT OF A PERINEURAL NERVE CATHETER IN PATIENT ROAD TO RECOVERY

Post surgical pain after major lower limb amputation is a major problem to the patients recovery. The majority of patients require continuous opioid analgesics and NSAIDs after surgery, which are associated with side-effects. In order to overcome the pain encountered by these patients, we routinely practice intraoperative placement of aNerve catheter along the peripheral nerve stump. The anesthetic medication is used to calm the nerves and overcome pain perceived by the patient. We study the effectiveness of pain control and reduction in the need for oral / parenteral administration of analgesics. This step could potentially reduce post-procedure analgesics usage and other related adverse effects.

Methods: A retrospective study and data review of 98 patients who had major lower limb amputation for peripheral vascular disease over a 5-year duration. Intra-operatively, 42 patients had a perineural catheter placement were compared to 56 patients who had oral and parenteral analgesics prescribed to treat post operative pain. The primary outcomes of this studywere the number and quantity of drug needed in the first 4 days postoperatively and swiftness in postoperative recovery to do rehabilitation.

Results: 98 major lower-limb amputations were selected. Analysis shows that perineural catheter use was associated with a decreased need for postoperative analgesics and decreased postoperative pain scores at 72 hours. Perineural catheter use led to a 65% reduction inopioid + NSAIDs use during the early postoperative period. Data also suggests the patient tend to fair better in rehabilitation work with nerve catheter placement.

Conclusions: Post operative continuous infusions of local anesthetic through nerve catheter are safe and effective in reducing pain post-amputation. The analgesic medications requirement after major lower limb amputation can be significantly lowered so are the complications.