Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial
Background and Aims: Many pain syndromes such as chronic phantom limb pain (PLP) and stump pain (SP), involving nociceptive and neuropathic pain, develop after amputation. Recent literature suggests that the use of regional blocks reduces repeated stimulation of transected nerve roots and thus preve...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2022;volume=66;issue=18;spage=300;epage=306;aulast=Makkar |
| _version_ | 1798018659112714240 |
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| author | Jeetinder Kaur Makkar Anjishnujit Bandyopadhay Kajal Jain Anudeep Jafra Nirmal R Gopinathan Preetmohinder Singh |
| author_facet | Jeetinder Kaur Makkar Anjishnujit Bandyopadhay Kajal Jain Anudeep Jafra Nirmal R Gopinathan Preetmohinder Singh |
| author_sort | Jeetinder Kaur Makkar |
| collection | DOAJ |
| description | Background and Aims: Many pain syndromes such as chronic phantom limb pain (PLP) and stump pain (SP), involving nociceptive and neuropathic pain, develop after amputation. Recent literature suggests that the use of regional blocks reduces repeated stimulation of transected nerve roots and thus prevents central sensitisation. This randomised, double-blind study was conducted to evaluate the effect of pre-emptive ultrasound-guided single-shot lateral sciatic nerve block on the occurrence of chronic pain at six months after traumatic below-knee amputation. Methods: Thirty patients undergoing traumatic lower limb amputation under general anaesthesia were randomised into two groups: Group B received sciatic nerve block pre-emptively using ultrasound with 20 ml of 0.75% ropivacaine, whereas group C received 20 ml of normal saline. Follow-up of patients was done till six months post-amputation. The primary objective was to assess the occurrence of chronic pain at six months. Pain at 15 days and one month after surgery, post-operative morphine consumption and post-operative nausea and vomiting (PONV) were the secondary outcomes assessed. Results: The occurrence of PLP at six months was comparable in the two groups, group B (46.7%) and C (66.7%). None of the patients developed SP at six months. Median intensities of phantom pain were 1.0 (range, 1–2.0) versus 1.0 (range, 1–2.0) (P = 0.36), and median intensities of SP 2 (range, 2–3.0) versus 3 (range, 2–3.0) (P = 0.39) at 1 month. Conclusion: Pre-emptive sciatic nerve block did not decrease the occurrence or severity of chronic pain after traumatic below-knee amputation. |
| first_indexed | 2024-04-11T16:28:02Z |
| format | Article |
| id | doaj.art-5f45f13d42244f9694ff0e6203ab8dd4 |
| institution | Directory Open Access Journal |
| issn | 0019-5049 0976-2817 |
| language | English |
| last_indexed | 2024-04-11T16:28:02Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj.art-5f45f13d42244f9694ff0e6203ab8dd42022-12-22T04:14:06ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172022-01-01661830030610.4103/ija.ija_796_21Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trialJeetinder Kaur MakkarAnjishnujit BandyopadhayKajal JainAnudeep JafraNirmal R GopinathanPreetmohinder SinghBackground and Aims: Many pain syndromes such as chronic phantom limb pain (PLP) and stump pain (SP), involving nociceptive and neuropathic pain, develop after amputation. Recent literature suggests that the use of regional blocks reduces repeated stimulation of transected nerve roots and thus prevents central sensitisation. This randomised, double-blind study was conducted to evaluate the effect of pre-emptive ultrasound-guided single-shot lateral sciatic nerve block on the occurrence of chronic pain at six months after traumatic below-knee amputation. Methods: Thirty patients undergoing traumatic lower limb amputation under general anaesthesia were randomised into two groups: Group B received sciatic nerve block pre-emptively using ultrasound with 20 ml of 0.75% ropivacaine, whereas group C received 20 ml of normal saline. Follow-up of patients was done till six months post-amputation. The primary objective was to assess the occurrence of chronic pain at six months. Pain at 15 days and one month after surgery, post-operative morphine consumption and post-operative nausea and vomiting (PONV) were the secondary outcomes assessed. Results: The occurrence of PLP at six months was comparable in the two groups, group B (46.7%) and C (66.7%). None of the patients developed SP at six months. Median intensities of phantom pain were 1.0 (range, 1–2.0) versus 1.0 (range, 1–2.0) (P = 0.36), and median intensities of SP 2 (range, 2–3.0) versus 3 (range, 2–3.0) (P = 0.39) at 1 month. Conclusion: Pre-emptive sciatic nerve block did not decrease the occurrence or severity of chronic pain after traumatic below-knee amputation.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2022;volume=66;issue=18;spage=300;epage=306;aulast=Makkaramputationchronic painnerve blockphantom limbpre-emptivesciatic nervestump painultrasound-guided |
| spellingShingle | Jeetinder Kaur Makkar Anjishnujit Bandyopadhay Kajal Jain Anudeep Jafra Nirmal R Gopinathan Preetmohinder Singh Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial Indian Journal of Anaesthesia amputation chronic pain nerve block phantom limb pre-emptive sciatic nerve stump pain ultrasound-guided |
| title | Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial |
| title_full | Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial |
| title_fullStr | Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial |
| title_full_unstemmed | Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial |
| title_short | Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial |
| title_sort | effect of perioperative sciatic nerve block on chronic pain in patients undergoing below knee amputation a randomised controlled trial |
| topic | amputation chronic pain nerve block phantom limb pre-emptive sciatic nerve stump pain ultrasound-guided |
| url | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2022;volume=66;issue=18;spage=300;epage=306;aulast=Makkar |
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