Systematic review and meta-analysis of the efficacy of perineural local anaesthetic catheters after major lower limb amputation

D C Bosanquet, J C D Glasbey, A Stimpson, I M Williams, C P Twine

Research output: Contribution to journalReview article (Academic Journal)

Abstract

OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the effects of using an intraoperatively placed perineural catheter (PNC) with a postoperative local anaesthetic infusion on immediate and long-term outcomes after lower limb amputation.

METHODS: A systematic review of key electronic journal databases was undertaken from inception to January 2015. Studies comparing PNC use with either a control, or no PNC, were included. Meta-analysis was performed for postoperative opioid use, pain scores, mortality, and long-term incidence of stump and phantom limb pain. Sensitivity analysis was performed for opioid use. Quality of evidence was assessed using the GRADE system.

RESULTS: Seven studies reporting on 416 patients undergoing lower limb amputation with PNC usage (n = 199) or not (n = 217) were included. Approximately 60% were transtibial amputations PNC use reduced postoperative opioid consumption (standardised mean difference: -0.59, 95% CI -1.10 to -0.07, p = .03), maintained on sensitivity analysis for large (p = .03) and high-quality (p = .003) studies, but was marginally lost (p = .06) on studies enrolling patients with peripheral arterial disease only. PNC treatment did not affect postoperative pain scores (p = .48), in-hospital mortality (p = .77), phantom limb pain (p = .28) or stump pain (p = .37). GRADE quality of evidence for all outcomes was very low.

CONCLUSION: There is poor-quality evidence that PNC usage significantly reduces opioid consumption following lower limb amputation, without affecting other short- or long-term outcomes. Well-performed randomised studies are required.

Original languageEnglish
Pages (from-to)241-9
Number of pages9
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume50
Issue number2
DOIs
Publication statusPublished - Aug 2015

Bibliographical note

Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Keywords

  • Amputation/adverse effects
  • Analgesics, Opioid/therapeutic use
  • Anesthetics, Local/administration & dosage
  • Catheterization/instrumentation
  • Catheters, Indwelling
  • Chi-Square Distribution
  • Humans
  • Infusions, Parenteral
  • Lower Extremity/surgery
  • Odds Ratio
  • Pain Measurement
  • Pain, Postoperative/diagnosis
  • Phantom Limb/etiology
  • Time Factors
  • Treatment Outcome

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