Prospective Randomized Controlled Trial for the Effect of Perineural Injection of Bupivacaine for Sciatic Nerve in above Knee Amputation on Postoperative Stump Pain

Abstract

Abstract Background Despite advances in limb-salvage surgery, lower extremity amputation is still commonly required as an end result of the progression of arterial occlusive disease, failed arterial reconstruction or sever infection. Furthermore, the increasing prevalence of diabetes has led to the appearance of more patients with foot complications leading to eventual lower extremity amputation. Objective To assess the efficacy of perineural injection of Bupivacaine for sciatic nerve in above knee amputation on postoperative stump pain and consumption of analgesia. Patients and Methods This is a prospective study, in which we follow up patients who went for above knee amputation and record the severity of post operative stump pain. The study included 30 patients undergoing lower limb amputation in Ain Shams University hospitals divided randomly into two groups each group of 15 patients, one group will receive the injection for sciatic nerve and the other group will not, postoperative pain follow up for one weeks, and the outcome measured is the severity of post operative stump pain. Results Regarding pain score assessment between the two groups at the first one week, there is highly significant decrease in pain score in our study group that received the perineural injection more than the other group at the first 18 hours postoperative (P-value <0.001), and there is significant decrease in pain score for the perineural injected group with P-value 0.013. Up to 36 hours there is decrease in pain score in group I than group II but with no significant statically results. Regarding the total analgesia (opioids) intake in group I Mean ±SD (1.8 ± 1.935) while in group II Mean ±SD (6 ± 1.69), group I in less than group II in total opioids in take in the first one week with p-value <0.001 with highly significant difference between the two groups. Conclusion Intraoperative perineural bupivacaine injection of sciatic nerve found to decrease the postoperative pain especially at the first 24 hours, and also decrease the opioids consumption and its side effects.