Peripheral nerve stimulation may reduce pain, opioid use after lower limb amputation
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Use of peripheral nerve stimulation may reduce pain scores and opioid consumption after lower limb amputation, according to results presented at the Regional Anesthesiology and Acute Pain Medicine Annual Meeting.
In their study, which received a Best of Meeting Abstract Award, Brooke Albright-Trainer, MD, FASA; Denise Lester, MD, and colleagues randomly assigned 16 veterans who were experiencing moderate pain 2 to 7 days after transfemoral or transtibial amputation to receive either 8 weeks of percutaneous peripheral nerve stimulation with standard medical therapy or standard medical therapy alone.
“We looked at residual and phantom limb pain scores, as well as [patient] opioid consumption, with baseline opioid consumption being before they even underwent surgery,” Albright-Trainer, anesthesiologist, intensivist and acute pain physician at Central Virginia VA Health Care System in Richmond, told Healio Orthopedics.
Secondary endpoints included readmission rates, length of stay, psychometric scales and functional outcomes, according to Albright-Trainer.
Reduction in limb pain
Lester noted a marked difference in phantom limb pain between the two groups at weeks 1 through 4, weeks 5 through 8 and at 3-month follow-up, with a 76% reduction in phantom limb pain from baseline in the peripheral nerve stimulation group at week 5 through 8.
“We also looked at residual limb pain and, at each moment that we checked, there was a marked difference in the amount of pain reduction with peripheral nerve stimulation vs. not,” Lester, who is a fellow American Board Anesthesiology and American Board Pain Management Anesthesiologist, told Healio Orthopedics. “The most remarkable was an 87% reduction in residual limb pain at week 5 through 8 – the biggest difference between the two groups.”
Decrease in opioid use
Although patients in the peripheral nerve stimulation group had higher opioid consumption preoperatively, Albright-Trainer said they had lower opioid consumption when discharged to rehabilitation. She added the difference in opioid consumption between the two groups was sustained throughout the acute to subacute period, with patients in the peripheral nerve stimulation group requiring fewer opioids. Patients in the peripheral nerve stimulation group also had greater reductions in average daily opioid usage compared with preoperative levels, according to results.
Lester noted 25% of patients who received standard medical therapy alone experienced readmission within 30 days of discharge vs. no readmissions in the peripheral nerve stimulation group.
“There were other secondary outcomes we were looking at, but those didn’t show any changes and we think that was because we need a bigger study,” Lester, who is an anesthesiologist, chronic pain physician, director of peripheral nerve stimulation and co-director of interventional pain research at Central Virginia VA Health Care System, said. “Once we get a large study designed, we’ll be able to look at some of these more subtle changes, like length of stay, functional-independence measures and pain interference scales.”
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Albright-Trainer B, et al. Paper 1968. Presented at: Regional Anesthesiology and Acute Pain Medicine Annual Meeting. May 13-15, 2021; Florida (hybrid meeting).
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