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COMPARISON OF ANAESTHETICALLY-PLACED VERSUS SURGICALLY-PLACED NERVE CATHETERS FOR POST-OPERATIVE LOWER LIMB AMPUTATIONS
Author(s):
Buckley, D.*
Affiliations:
Freeman Hospital, Anaesthesia, Newcastle Upon Tyne, United Kingdom
ESRA Academy. Buckley D. Sep 13, 2017; 190853; 56 Topic: ADJUVANT DRUGS
Dr. David Buckley
Dr. David Buckley

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Abstract
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Background and Aims:

Pre-incision nerve catheters placed by anaesthetists using ultrasound or nerve stimulators for post-operative pain control for lower limb amputations are commonplace. However, if no suitably trained anaesthetists are present, surgeons insert nerve catheters under direct vision at the end of the procedure. To date, no comparison has been made between these two techniques in my institution to show which resulted in superior short-term pain relief. 

Methods:

Using our local pain database, information regarding pain scores in recovery (0 to 10), the duration of local anaesthetic infusion (hours) and the overall patient satisfaction (poor = 0, fair = 1, good =2, excellent =3) were obtained.

Results:

Thirty-five patients had nerve catheters inserted for lower limb amputations in the past year. Anaesthetists placed 30 catheters pre-incision and surgeons placed 5 catheters under direct vision at the end of the procedure. 

The overall results show a surprising similarity in all the factors assessed. Comparing the nerve catheters placed by anaesthetists to those placed by surgeons, the average pain score in recovery was 2.0 vs. 2.5, the average time of local anaesthetic infusion was 6.7 vs. 6.44 hours and the overall patient satisfaction was 2.8 vs. 2.75. 

Conclusions:

The similarity in outcomes of these two types of techniques show that neither gives superior short-term outcomes when compared to the other. 

However, given that in the long term pre-incision blocks may reduce the occurrence of long-term phantom limb pain (Becott, et al., 2008), we should be looking to insert more pre-incision catheters.

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