ESRA Academy. Tameem A. Sep 8, 2016; 138568; 0442 Topic: Lower Limb Amputation
Disclosure(s): Nothing to disclose
Dr. Alifia Tameem
Dr. Alifia Tameem

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Background and Aims:

An audit carried out in 2012 at our institute highlighted moderate to severe postoperative pain in 74% of the patients undergoing major lower limb amputation (Drs Hodges, Smith, Eagland). Continuous peripheral nerve blockade via a local anaesthetic perineural catheter (PNC) has been shown to improve analgesia and reduce opioid-related side effects. Following the audit, a multimodal perioperative pain guideline was devised and implemented including insertion of a PNC for lower limb amputations. Here we discuss our results.


Sixty-eight patients who underwent either elective/emergency above (AKA), through (TKA) or below knee amputations (BKA) prior to the guideline introduction and 56 patients following the guideline introduction were compared. The highest pain score for 6 postoperative days were reviewed. Pain scores were analysed based on a numerical rating scale of 0–3 (0 = no pain, 1 = mild, 2 = moderate and 3 = severe pain).


A greater proportion of patients were pain free in the postoperative period (pain score = 0) compared to pre guideline (74% vs. 60%). Seventy-four percent in the pre guideline group had pain score >1 at least once in the postoperative period. After introduction of the guideline, 43% had a pain score >1.  Twenty-six percent of patients received a patient controlled analgesia (PCA) prior the guideline compared to 4% after the guideline


Following the introduction of a guideline involving PNC placement for major lower limb amputation, there was a reduction of pain scores, fewer PCA prescriptions and benefits of opiate sparing properties were seen. 

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