Impact of Regional versus General Anesthesia on the Clinical Outcomes of Patients Undergoing Major Lower Extremity Amputation

Chery, Josue; Semaan, Elie; Darji, Sandipkumar; Briggs, William T.; Yarmush, Joel; D’Ayala, Marcus

doi:10.1016/j.avsg.2013.07.033

Cited by 43 publications

(34 citation statements)

References 21 publications

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“…They concluded that RA was associated with a significantly lower incidence of overall postoperative pulmonary complications, decreased postoperative arrhythmia, decreased stay in the intensive care unit, and reduced hospital stay. 8 However, no difference was noted in mortality, postoperative myocardial infarction, or venous thromboembolisms between patients receiving RA and those receiving GA.…”

Section: Discussionmentioning

confidence: 94%

“…For instance, major LEAs with gangrene carry a 2-year mortality as high as 30%. 8 There have been prior attempts to compare the outcomes with the use of regional anesthesia (RA), such as neuraxial or a peripheral nerve blockade, with those with general anesthesia (GA) in patients undergoing revascularization procedures of the lower extremity. 9,10 Previous work has demonstrated advantages of RA in lower-extremity procedures including decreased pulmonary complications, lower risk of arterial and venous thrombosis, avoidance of mechanical ventilation, and a reduced requirement of blood transfusions.…”

mentioning

confidence: 99%

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The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Malik

Brovman

Urman

2018

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

Malik

Brovman

Urman

2018

Regional Anesthesia and Pain Medicine

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“…[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] …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation.A total of 59 consecutive patients with a diabetic foot who underwent distal foot amputation between January 2012 and May 2014 were retrospectively reviewed. Patients received remifentanil-based GEA (GEA group, n = 32) or PNB (PNB group, n = 27). The primary outcomes were to evaluate postoperative analgesic effects and perioperative hemodynamics. Also, postoperative pulmonary complications and 6-month mortality were assessed as secondary outcomes.Significant differences in pain scores using numeric rating scale were observed between the groups in a linear mixed model analysis (PGroup×Time = 0.044). Even after post hoc analysis with the Bonferroni correction, the numeric rating scale scores were significantly lower in the PNB group. Furthermore, patients in the PNB group required less pethidine during the first 6 hours after surgery (27 ± 28 vs 9 ± 18 mg; P = 0.013). The GEA group had a lower mean blood pressure (Bonferroni-corrected P < 0.01), despite receiving more ephedrine (P < 0.001). Significantly more patients in the GEA group suffered from postoperative pneumonia and required the management in intensive care unit (P = 0.030 and 0.038, respectively). However, the groups did not differ in terms of 6-month mortality.This study demonstrated that compared with remifentanil-based GEA, PNB might be a favorable option for diabetic patients undergoing distal foot amputation, despite the lack of significant mortality benefits, as PNB was associated with improved postoperative analgesia, hemodynamic stability, and a low incidence of pulmonary complications during the immediate postoperative period, especially in high-risk patients.

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“…This is consistent with our data showing significantly more patients in the antithrombotic treatment group than in the CINPWT group. 17 missing details in medical journals, it was not possible in the present study to take minor revisions in the orthopaedic ward into account. 16 A strength of our study was the inclusion of all consecutive patients over an 8-year period.…”

Section: Discussionmentioning

confidence: 99%

Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

Stenqvist

Nielsen

Napolitano

et al. 2019

International Wound Journal

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Closed incision negative pressure wound therapy (CINPWT) has been shown to be clinically effective compared with the traditional gauze dressing, reducing surgical site infections and wound complications. We evaluated the effect of CINPWT compared with gauze dressing on the need for revision surgery and survival after non‐traumatic major lower amputation. We included 309 patients undergoing 403 major lower amputations in a retrospective study from January 1, 2010 to November 23, 2017. A total of 139 patients received CINPWT, and 170 patients received stump bandage. There was no statistically significant difference between the two groups regarding the need for revision surgery (P = .45). Fourteen stump bandage patients and 15 CINPWT patients died in hospital (P = .57). One year after amputation, 55 CINPWT patients and 66 stump bandage patients had died (P = .82). Survival probabilities adjusted for age and gender 2 years after amputation were .52 (.43‐.61) and .49 (.42‐.58), respectively, and 3 years after amputation were .36 (.25‐.50) and .39 (.32‐.47), respectively. We also found no significant difference in the need for revision surgery in survival probabilities up till 3 years after amputation between patients treated with CINPWT and patients treated with gauze bandage postoperatively.

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Impact of Regional versus General Anesthesia on the Clinical Outcomes of Patients Undergoing Major Lower Extremity Amputation

Cited by 43 publications

References 21 publications

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions

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

Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

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