Effects of anesthesia versus regional nerve block on major leg amputation mortality rate

Abstract

There are greater than 120,000 above-knee amputations (AKA) and below-knee amputations (BKA) performed in the USA each year. Traditionally, general anesthesia (GA) was the preferred modality of anesthesia. The use of regional nerve blocks has recently gained popularity, however, without the supporting evidence of any mortality benefits. Our objective was to evaluate whether regional nerve blocks yield significant mortality reduction in major lower-extremity amputations. Retrospective data of both AKA and BKA procedures at the Maimonides Medical Center from 2005 to 2009 were analyzed. Patients received either general sedation, spinal or ultrasound-guided regional nerve blocks as per decision of the attending anesthesiologist. Regional nerve blocks for major lower-extremity amputations consisted of femoral, sciatic, saphenous and popliteal nerve blocks. A retrospective inquiry of 30-day mortality was performed with reference to the Social Security Death Index and hospital records. One hundred and fifty-eight patients were included in the study (82 men and 86 women with mean age of 74.5 years ± 12.9 SD, range of 33-98 years) of which 46 patients had regional nerve blocks and 112 had GA or spinal blocks. Patients who received both regional blocks and GA/spinal blocks within 30 days were excluded. The overall 30-day mortality was 17.1% (27 patients) consisting of 15.2% for regional nerve analgesia versus 17.9% for GA/spinal blocks (P = 0.867). Age did not affect mortality outcome in either groups of anesthesia modality. Our analysis did not reveal any mortality benefit of utilizing regional nerve block over GA or spinal blocks.

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

“…132 For leg amputation, no benefit has been shown for sciatic nerve block compared with general anaesthesia. 133 Functional recovery. For patients with total knee replacement, functional outcome after combined sciatic and femoral nerve block was similar to periarticular infiltration 115 or epidural anaesthesia.…”

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

“…[16] Given the increasing interest in peripheral nerve block, a large number of cases reported in several countries support the use of peripheral nerve block instead of GEA. [11,17,18] Although reports have described the effects of peripheral nerve block in patients undergoing major LEA, such as above- or below-knee amputation, no studies have investigated these effects in patients undergoing minor LEA, such as distal foot amputation.…”

“…[11,17,18] Although reports have described the effects of peripheral nerve block in patients undergoing major LEA, such as above- or below-knee amputation, no studies have investigated these effects in patients undergoing minor LEA, such as distal foot amputation. [16,19,20] …”

Anesthesia and Perioperative Care

“…Intralipid, the treatment for intravascular injection of bupivacaine (Mirtallo and others 2010) is approximately US$100-US$300 per dose and not routinely available in LMICs; for this reason alone, lidocaine is cost saving in LMICs. Literature from HICs compares regional, local, and general anesthesia safety and outcomes; on balance, there is no consensus that regional and local anesthesia are superior to general anesthesia (Lin and others 2013). However, there is no evidence that regional and local anesthesia are inferior.…”