EP039 Perioperative peripheral nerve blockade and acute pain management in traumatic limb amputations – A single-centre, retrospective observational study

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant <h3>Background and Aims</h3> Limb amputations are a significant consequence of major trauma, and can result in acute and chronic pain. Acute pain management is crucial for recovery and rehabilitation. Severe postoperative pain is a risk factor for developing chronic post-surgical pain, and is potentially modifiable. Evidence shows peripheral nerve blockade (PNB) reduces perioperative opiate consumption. Some studies suggest regional anaesthesia may decrease risk of chronic pain, but they are small and not specific to major trauma. This study aimed to identify acute benefits using PNB in major trauma patients undergoing limb amputations. <h3>Methods</h3> This retrospective study reviewed all patients who underwent limb amputation under Trauma and Orthopaedics at our tertiary centre between 21/07/2020 and 19/10/2023. We reviewed case notes to identify intraoperative analgesia, pre-operative and postoperative opiate requirements, and postoperative function qualified as engagement with physiotherapy. <h3>Results</h3> 69 patients were identified (64 lower limb amputation, 5 upper limb amputation). Surgical indications included traumatic injury (n=42), osteomyelitis (n=26), and chronic pain (n=1). 33% (n=23) received PNB catheter, 42% (n=29) received PNB single-shot, and 25% (n=17) did not get PNB. <h3>Conclusions</h3> This observational study demonstrated reduction in postoperative opiate consumption in patients receiving PNB, with lowest consumption in those receiving PNB catheter. PNB patients had higher rate of engagement with physiotherapy postoperatively. Limitations to this study were small cohort size, varied surgical indications and the no PNB group may have included more unwell or multiple injured patients. More data is needed to establish benefits of PNB.