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. 2024 Sep 15;16(9):e69458.
doi: 10.7759/cureus.69458. eCollection 2024 Sep.

Peripheral Nerve Blocks as a Predictor of Nerve Reconstruction Success After Major Limb Amputation

Daisy E Martinez  1 , Anthony G DeMartino  1 , Georg J Furtmüller  2 , Khanjan Nagarsheth  2
Affiliations

Peripheral Nerve Blocks as a Predictor of Nerve Reconstruction Success After Major Limb Amputation

Daisy E Martinez et al. Cureus. .

Abstract

Postamputation pain is a spectrum of debilitating sensations that impacts millions of people in the United States. While the development of postamputation pain, including phantom limb pain (PLP), is multifactorial, it has been associated with disorganized axonal sprouting, resulting in a neuroma and subsequent central nervous system changes. Nerve reconstruction surgeries, such as regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR), provide transected nerve fibers with proper target organs for reinnervation and have been shown to significantly reduce PLP. This case series aims to describe perioperative peripheral nerve blocks as a diagnostic tool for identifying patients who would benefit from RPNI or TMR. We conducted a retrospective search of patients who underwent major extremity amputation and who received a diagnostic peripheral nerve block before undergoing reconstructive nerve surgery (TMR and/or RPNI). Six patients (58-80 years old) with below-knee amputations (BKA) were examined. All patients experienced a reduction in postamputation pain (PAP), specifically PLP, after a diagnostic peripheral nerve block (PNB). The average time between amputation and revision surgery was approximately two years (Mean: 22.35 months). Following surgical intervention, all patients reported a reduction in PLP episodes after nerve reconstruction surgery. Two patients no longer reported PLP. Ambulation rates also improved following revision (50% vs 83%). PNBs can be used as an effective diagnostic tool to identify patients that will significantly benefit from amputation revisions with TMR or RPNI.

Keywords: neuroma; peripheral nerve block; postamputation pain; regenerative peripheral nerve interface; targeted muscle reinnervation.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board at the University of Maryland Medical Center issued approval HP-00099041. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Prevalence of PLP and patient ability to ambulate before and after nerve reconstruction surgery
The table lists the number of patients experiencing no pain, intermittent pain, or constant pain. Ambulation with assistance includes devices such as canes and walkers (excluding prosthetics). PLP: Phantom limb pain.
See this image and copyright information in PMC

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