Niskakangas M, et al. - This study compared postoperative analgesic requirements in patients who received either spinal anaesthesia or general anaesthesia for major limb amputation attributed to lower-limb ischaemia. Also, researchers investigated whether anaesthesiologists use neuraxial anaesthesia in high-risk patients despite abnormal coagulation profile or use of anticoagulation. It was observed that rate of surgical complications, re-operations and intensive care unit admissions were lower with spinal anaesthesia. Compared with general anaesthesia group, a lesser need for postoperative opioid medication was seen in patients with above-the-knee amputation and spinal anaesthesia. Furthermore, despite abnormal coagulation profile or ongoing anticoagulation, neuraxial anaesthesia and/or analgesia was performed by anaesthesiologists in high-risk patients and, no adverse outcomes were reported.

Methods

• In this retrospective cohort study, researchers reviewed all patients who underwent above-the-knee amputation or below-the-knee amputation due to peripheral artery disease between 1996 and 2010, in order to assess post-operative opioid consumption and complications.

Results

• This study included overall 434 amputations in 323 patients.
• Researchers observed that the general anaesthesia group had significantly higher number of surgical complications, the need for surgical revision and the number of intensive care unit admissions.
• They also noted that in patients with above-the-knee amputation and spinal anaesthesia, the requirement for post-operative opioid medication was significantly lower.
• In addition, data reported no reduction in the analgesic requirements after the use of post-operative epidural analgesia.
• Notably, there were patients who received neuraxial anaesthesia despite abnormal coagulation profile or uninterrupted warfarin or clopidogrel.
• Additionally, no cases of spinal or epidural haematoma were reported.