D C Bosanquet1, J C D Glasbey2, A Stimpson3, I M Williams2, C P Twine3. 1. South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, UK. Electronic address: davebosanquet@hotmail.com. 2. South East Wales Regional Vascular Network, University Hospital of Wales, Cardiff, UK. 3. South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, UK.
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.
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.
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Authors: David C Bosanquet; Graeme K Ambler; Cherry-Ann Waldron; Emma Thomas-Jones; Lucy Brookes-Howell; Mark Kelson; Debbie Harris; Timothy Pickles; Sarah Milosevic; Deborah Fitzsimmons; Neeraj Saxena; Christopher P Twine Journal: Br J Pain Date: 2018-09-20
Authors: David C Bosanquet; Graeme K Ambler; Cherry-Ann Waldron; Emma Thomas-Jones; Lucy Brookes-Howell; Mark Kelson; Tim Pickles; Debbie Harris; Deborah Fitzsimmons; Neeraj Saxena; Christopher P Twine Journal: Trials Date: 2017-12-28 Impact factor: 2.728
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Authors: David C Bosanquet; Graeme K Ambler; Cherry-Ann Waldron; Emma Thomas-Jones; Lucy Brookes-Howell; Mark Kelson; Timothy Pickles; Debbie Harris; Sarah Milosevic; Deborah Fitzsimmons; Neeraj Saxena; Christopher P Twine Journal: BMJ Open Date: 2019-11-11 Impact factor: 3.006