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.
|Number of pages||9|
|Journal||European Journal of Vascular and Endovascular Surgery|
|Publication status||Published - Aug 2015|
Bibliographical noteCopyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
- Amputation/adverse effects
- Analgesics, Opioid/therapeutic use
- Anesthetics, Local/administration & dosage
- Catheters, Indwelling
- Chi-Square Distribution
- Infusions, Parenteral
- Lower Extremity/surgery
- Odds Ratio
- Pain Measurement
- Pain, Postoperative/diagnosis
- Phantom Limb/etiology
- Time Factors
- Treatment Outcome