Utility of Peripheral Nerve Block in Lower Extremity Amputation.

Publication/Presentation Date

1-1-2026

Abstract

BACKGROUND: Approximately 200,000 limb amputations (LA) occur annually in the United States, with almost two million people living with limb loss. Phantom limb pain (PLP) is a common sequela of LA, and accounts for $12 billion in health care expenditure. The optimal anesthetic modality to reduce PLP and improve perioperative outcomes remains unclear. This study evaluated whether peripheral nerve block (PNB), used as a primary anesthetic modality, improves perioperative outcomes compared with general anesthesia (GA) in lower extremity amputation (LEA).

METHODS: A single-institution retrospective review was conducted of adult patients undergoing first-time LEA between January 2019 and June 2020. Patients were stratified by anesthetic techniques: GA, PNB, neuraxial anesthesia, or GA combined with PNB. Outcomes included incidence of PLP, length of hospital stay, opioid requirements within the first 72 hours, and operative/anesthetic time. Statistical analyses included ANOVA, chi-square testing, and multivariable regression with robust standard errors.

RESULTS: 193 records were reviewed; 179 met inclusion criteria. GA was used in 54% of cases, GA+PNB in 44%, and PNB or neuraxial anesthesia in 2%. Patients receiving PNB alone were older and had higher BMI, with a greater proportion undergoing below-knee amputation. PLP incidence was lower in GA compared with GA+PNB (8% vs 14%), though not statistically significant. Notably, no cases of PLP occurred in patients receiving PNB alone. PNB use was associated with lower opioid requirements and a significant reduction in operative time, while hospital length of stay was similar across groups. Phantom limb pain did not differ significantly between groups (GA+PNB vs GA),

CONCLUSION: Overall, PNB demonstrated potential benefits in reducing opioid use and operative time, with promising findings regarding PLP prevention. These results support further prospective, randomized trial of PNB as a primary anesthetic strategy for LEA.

Volume

19

First Page

588924

Last Page

588924

ISSN

1178-7090

Disciplines

Anesthesiology | Medicine and Health Sciences

PubMedID

41924087

Department(s)

Department of Anesthesiology

Document Type

Article

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