Enhanced Post-Operative Recovery with Continuous Peripheral Nerve Block After Lower Extremity Amputation.

Abstract

BACKGROUND:

Despite progress in perioperative care standards, there has not been a significant risk reduction in morbidity and mortality rates of lower extremity amputations, an intermediate risk surgery performed on high risk patients. The single-shot peripheral nerve block has shown equivocal impact on postoperative course following lower extremity amputation. Hence, we assessed the potential of preemptive use of continuous catheter-based peripheral nerve block in lower extremity amputations for reduction in pulmonary complications, acute post-operative pain scores, and opioid use in post-operative period.

METHODS:

A retrospective review of a quality improvement project initiated in 2018 was conducted to compare outcomes amongst general anesthesia in combination with a catheter-based peripheral nerve block (catheter group) and general anesthesia alone in patients receiving lower extremity amputation. The rate of postoperative pulmonary complications was identified as a primary endpoint. The secondary outcomes assessed were acute post-operative pain scores and opioid consumption up to 48 hours. Our analysis was adjusted for potential confounding variables inclusive of demographics, medical comorbidities, type of surgical procedure and smoking status.

RESULTS:

Ninety-six patients were included in the study (61 in the general anesthesia group, 35 in the catheter group). After adjusting for baseline demographics, comorbidities, surgical technique and smoking status, the odds of postoperative pulmonary complications were significantly lower with catheter-based peripheral nerve block in comparison to general anesthesia alone, OR 0.11 [95% CI, 0.01- 0.88] (P = 0.048). The decrease in acute pain scores was also observed in the catheter group when compared to general anesthesia alone, OR 0.72 [95% CI, 0.56 - 0.93] (P = 0.012). Similarly, the opioid consumption was also lower in the catheter group in comparison to general anesthesia alone, OR 0.97 [95% CI, 0.95 - 0.99] (P = 0.025).

CONCLUSION:

Preemptive use of continuous peripheral nerve block in patients undergoing lower extremity amputation reduces the incidence of pulmonary complications, acute postoperative pain scores and narcotic use in post-operative period.

• Authors: Huma Fatima, Omar Chaudhary, Santiago Krumm, Syed Hamza Mufarrih, Feroze Mahmood, Ameeka Pannu, Aidan Sharkey, Vincent Baribeau, Nada Qureshi, Victor Polshin, Ruma Bose, Allen D Hamdan, Marc L Schermerhorn, Robina Matyal
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 76 Pg. 399-405 (Oct 2021) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 33895258 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Chemical References

• Analgesics, Opioid

Topics

• Aged
• Amputation, Surgical (adverse effects)
• Analgesics, Opioid (therapeutic use)
• Anesthesia, General (adverse effects)
• Databases, Factual
• Female
• Humans
• Lower Extremity (innervation, surgery)
• Lung Diseases (diagnosis, etiology, prevention & control)
• Male
• Middle Aged
• Nerve Block (adverse effects)
• Pain Management (adverse effects)
• Pain Measurement
• Pain, Postoperative (diagnosis, etiology, prevention & control)
• Recovery of Function
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome