• Hanna von Plato, Marko Peltoniemi, Petteri Kauhanen, Eliisa Löyttyniemi, Katri Hamunen, Vesa Kontinen, and FinAPain-1 study group.
• Division of Perioperative Care, Department of Anesthesiology, Intensive Care and Pain Medicine, Jorvi Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
• Acta Anaesthesiol Scand. 2019 Nov 1; 63 (10): 1406-1412.

BackgroundPost-operative pain after an above-knee amputation is often severe, and in the elderly patients the adverse effects of post-operative opioids are evident. We hypothesized that continuous perineural local anesthetic infusion (CPI) combined to a wound infusion will reduce acute pain and opioid consumption compared to placebo after above knee amputation.MethodsNinety-three patients going through an above knee amputation were recruited for this randomized, controlled trial. Two catheters were placed, one to the sciatic nerve sheath and one under the fasciae during the amputation. After two 10 mL boluses of ropivacaine 0.75% a post-operative infusion of ropivacaine 0.2% or placebo (NaCl 0.9%) at 2 mL/h was administered for 72 hours to both catheters. The primary outcome was average stump pain during the first 5 days.ResultsThe mean intensity of stump pain during the first five post-operative days was 1.4 (0.8) in the CPI group and 1.9 (0.9) in the placebo group on VRS, mean (SD), P = .006. The opioid consumption on first five post-operative days did not differ between the groups.ConclusionA combination of continuous perineural and wound local anesthetic infusion seems to diminish the intensity of stump pain after above knee amputation.© 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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