Pain management using a novel hybrid technique of perineural stimulation combined with regional anaesthesia through a stimulating perineural catheter for below knee amputation

Abstract

Pain after amputation can be difficult to manage due to its complex aetiology. A multimodal approach to analgesia, including regional anaesthetic techniques, is advised. However, optimal pain management cannot always be achieved, and high doses of opioid analgesics may contribute to adverse effects. We describe the management of an elderly patient with significant co-morbidities undergoing below knee amputation. Pre-operatively, a popliteal sciatic stimulating perineural catheter and a femoral non-stimulating perineural catheter were placed. When pain control was suboptimal on the first postoperative day, a combination of local anaesthetic and a brief period of peripheral nerve stimulation through the sciatic stimulating perineural catheter was used to augment pain control, thereby avoiding additional opioid use. Although nerve stimulation utilising specialised equipment, such as percutaneous stimulator electrodes, has been previously described in acute pain medicine, we demonstrate the use of a novel hybrid technique which combines nerve stimulation through a perineural catheter and local anaesthetic. Further research is warranted to explore the utility of this neuromodulation technique in clinical practice.