Systematic Review and Meta-Analysis of the Effect of Perineural Catheters in Major Lower Limb Amputations

Laloo, Ryan; Ambler, Graeme K.; Locker, Dafydd; Twine, Christopher P.; Bosanquet, David C.

doi:10.1016/j.ejvs.2021.03.008

Cited by 12 publications

(17 citation statements)

References 28 publications

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“…Interview participants reported the PNC was effective in relieving postoperative pain. This supports quantitative findings that PNC use may significantly reduce opioid consumption 14 15. Participants particularly valued receiving localised, continuous analgesia, and found the placement of the PNC acceptable.…”

Section: Discussionsupporting

confidence: 73%

“…There is evidence to suggest that placement of a perineural catheter (PNC) adjacent to a major nerve at the time of amputation, delivering a continuous infusion of local anaesthetic to the surgical site, may be effective in reducing acute pain following major lower limb amputation (amputation at a level above the ankle joint). A review and meta-analyses14 15 showed opioid consumption was significantly lower among patients receiving a PNC following amputation than among controls. However, the authors noted that the quality of available evidence was low, indicating a need for a randomised controlled trial to fully establish the efficacy of the PNC in reducing acute pain.…”

Section: Introductionmentioning

confidence: 99%

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Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

et al. 2021

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ObjectivesTo explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation.DesignQualitative interview study, conducted as part of a randomised controlled feasibility trial.SettingParticipants were recruited from two general hospitals in South Wales.ParticipantsInterview participants were patients enrolled in PLACEMENT (Perineural Local Anaesthetic Catheter aftEr Major lowEr limb amputatioN Trial): a randomised controlled feasibility trial comparing the use of perineural catheter (PNC) versus standard care for postoperative pain relief following major lower limb amputation. PLACEMENT participants who completed 5-day postoperative follow-up, were able and willing to participate in a face-to-face interview, and had consented to be contacted, were eligible to take part in the qualitative study. A total of 20 interviews were conducted with 14 participants: 10 male and 4 female.MethodsSemi-structured, face-to-face interviews were conducted with participants over two time points: (1) up to 1 month and (2) at least 6 months following amputation. Interviews were audio-recorded, transcribed verbatim and analysed using a framework approach.ResultsInterviews revealed unanticipated benefits of PNC usage for postoperative pain relief. Participants valued the localised and continuous nature of this mode of analgesia in comparison to opioids. Concerns about opioid dependence and side effects of pain relief medication were raised by participants in both treatment groups, with some reporting trying to limit their intake of analgesics.ConclusionsFindings suggest routine placement of a PNC following major lower limb amputation could reduce postoperative pain, particularly for patient groups at risk of postoperative delirium. This method of analgesic delivery also has the potential to reduce preoperative anxiety, alleviate the burden of pain management and minimise opioid use. Future research could further examine the comparison between patient-controlled analgesia and continuous analgesia in relation to patient anxiety and satisfaction with pain management.Trial registration numberISRCTN: 85710690; EudraCT: 2016-003544-37.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

et al. 2021

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“…40,41 Soaker catheters with intermittent administration of local anaesthetics into the surgical site over a period of days following surgery are considered to provide extended periods of local analgesia. [42][43][44] We found that in this population of dogs, highintensity analgesic support (as defined in our approach) was strongly and significantly associated with prolonged overall survival. Given that all dogs had undergone limb amputation, this suggests a difference in time to metastasis.…”

Section: Discussionmentioning

confidence: 69%

“…Longer acting liposomal formulations of bupivacaine are now available; that formulation was infrequently used in the cases reported herein and while we acknowledge the duration of analgesia may have been longer than dogs treated with tissue infiltration of lidocaine or bupivacaine, dogs treated with liposomal formulations of bupivacaine as tissue infiltrations were placed in the low analgesic group 40,41 . Soaker catheters with intermittent administration of local anaesthetics into the surgical site over a period of days following surgery are considered to provide extended periods of local analgesia 42–44 . We found that in this population of dogs, high‐intensity analgesic support (as defined in our approach) was strongly and significantly associated with prolonged overall survival.…”

Section: Discussionmentioning

confidence: 97%

Intensity of perioperative analgesia but not pre‐treatment pain is predictive of survival in dogs undergoing amputation plus chemotherapy for extremity osteosarcoma

Nolan

Uzan

Green

et al. 2022

Vet Comparative Oncology

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The purpose of this bi‐institutional retrospective study was to determine whether, in dogs treated with limb amputation and adjunctive chemotherapy for osteosarcoma, oncologic outcomes are impacted by either: (1) baseline cancer pain severity, or (2) the approaches used for perioperative pain management. Data were extracted from the medical records of 284 dogs that underwent both limb amputation and chemotherapy (carboplatin and/or doxorubicin) between 1997 and 2017 for localized (non‐metastatic) osteosarcoma of the appendicular skeleton. Kaplan–Meier survival curves and Cox proportional hazard (PH) models were used to determine the impact that retrospectively scored baseline pain levels (high vs. low) and various analgesic and local anaesthetic treatments had on both metastasis‐free survival and all‐cause mortality. For the entire population, the median disease free interval and median overall survival times were 253 and 284 days, respectively. Baseline pain was rated as “low” in 84 dogs, and “high” in 190 dogs; pain severity had no detectable effect on either metastasis‐free survival or all‐cause mortality. When accounting for the potential influences of known prognostic factors, dogs treated with what was characterized as a high‐intensity perioperative analgesic plan (including both a non‐steroidal anti‐inflammatory drug [NSAID] and a bupivacaine‐eluting soaker catheter placed at the amputation site) had a higher probability of survival than dogs treated with a low‐intensity perioperative analgesic plan (neither an NSAID, nor a soaker catheter); the median overall survival times were 252 and 378 days, respectively (hazard ratio: 2.922; p = .020).

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“…It is likely this difference reflects the difference of literature evaluating these two catheter-based techniques, however lack of expertise was the commonest reason reported in the survey. [4][5][6] .…”

Section: Discussionmentioning

confidence: 99%

The PReliMinAry (Pain Relief in Major Amputation) Survey

Shelmerdine

Gwilym

Ambler

et al. 2022

Annals of Vascular Surgery

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Systematic Review and Meta-Analysis of the Effect of Perineural Catheters in Major Lower Limb Amputations

Cited by 12 publications

References 28 publications

Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

Intensity of perioperative analgesia but not pre‐treatment pain is predictive of survival in dogs undergoing amputation plus chemotherapy for extremity osteosarcoma

The PReliMinAry (Pain Relief in Major Amputation) Survey

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