Best of Meeting Abstract: Peripheral Nerve Blockade Reduces Patient Opioid Use After Amputation Surgery

Newswise — Peripheral nerve blockade with standard local anesthetic plus liposomal bupivacaine was associated with substantially lower opioid use after major lower-extremity amputation when compared to no peripheral nerve blockade, according the results of a study from the Mayo Clinic in Rochester, MN. The findings are of particular interest given the current U.S. opioid burden and epidemic. 

Catalina I. Dumitrascu, MD, Nafisseh S. Warner, MD, Thomas M. Stewart, MD, Adam W. Amundson, MD, Danette L. Bruns, RRT, LRT, Andrew C. Hanson, Phillip J. Schulte, PhD, Mark M. Smith, MD, Michael J. Brown, MD, Adam D. Niesen, MD, Carlos B. Mantilla, MD, PhD, and Matthew A. Warner, MD received a Resident/Fellow Travel Award for their abstract of the study, “Comparison of Three Perioperative Analgesic Approaches for Patients Undergoing Major Lower-Extremity Amputation,” which will be presented on Thursday, April 11, 2019, during the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, NV.

Pain control for patients undergoing major lower extremity amputation continues to be a challenge, with 30%–80% of patients developing chronic pain after amputation. Many pain relief strategies have been studied but an optimal approach is unclear.

In a retrospective cohort study, researchers examined pain-related outcomes in 641 adult patients who underwent lower extremity amputation between 2012 and 2017. Patients were divided into three groups: no peripheral nerve blockade (n = 416), peripheral nerve blockade with standard local anesthetic (n = 84), and peripheral nerve blockade with a mixture of standard local anesthetic and liposomal bupivacaine (n = 131), which is a longer-acting local anesthetic medication that was used off label for the study.

Although the addition of liposomal bupivacaine was associated with substantially lower opioid use after surgery compared to no peripheral nerve blockade, total opioid use was not statistically different when comparing this novel pain relief strategy with more traditional peripheral nerve blockade using standard local anesthetic alone.

“This study suggests that peripheral nerve blockade is a good choice for pain control  in patients undergoing major lower-extremity amputation,” the authors concluded. They added that future studies should further compare differences in both short-term and long-term pain-related outcomes when using different medication strategies with peripheral nerve blockade. 

The 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting will be held April 11–13, 2019, in Las Vegas, NV. The conference brings together worldwide experts in acute pain medicine to discuss standard and novel techniques, new pain targets, and strategies to address the opioid epidemic.