Targeted Muscle Reinnervation To Combat Chronic Opioid Use In Amputees
Corinne Wee, David E. Kurlander, Sam Boas, Anand Kumar, Joseph Khouri.
University Hospitals, Cleveland, OH, USA.
PURPOSE: Nearly 200,000 Americans undergo amputation annually, with a profound impact on quality of life. The prevalence of chronic limb pain is estimated to be as high as 70%, placing these patients at high risk of chronic opioid use. Targeted Muscle Reinnervation (TMR) was first described in 2002 and has been shown to reduce patient-reported pain symptoms. The effect of TMR on chronic opioid consumption in amputees remains understudied. The aim of this study was to evaluate the effectiveness of TMR in decreasing opioid use after amputation surgery. We hypothesized that TMR decreases chronic opioid consumption in amputees.
METHODS: This is a retrospective cohort study of all patients having undergone amputation with immediate or delayed TMR by a single surgeon from April through August 2019. Data collected included surgical site, indications, pre-operative opioid use, and opioid use at 30 and 90 days post-operatively. Opioid use after 90 days post-operatively was considered to be chronic. Statistical analysis included Fisher's Exact Test to compare chronic use in our patients to published opioid consumption rates in amputees and was performed using IBM SPSS Version 25.
RESULTS: Seven patients underwent TMR during this time period, with one excluded for inadequate follow-up. The six patients included in this study all underwent lower extremity amputation: three for infectious etiologies and three for vascular disease. One patient (17%) had documented chronic opioid use prior to amputation surgery and continued to require chronic opioids. None of the five opioid-na´ve patients required opioids at 30 or 90 day follow up. Compared to the published rate of 20% chronic opioid use in previously opioid-na´ve amputees, our study cohort required chronic opioids at a lower rate, but this was not statistically significant (p = 0.3).
CONCLUSIONS: TMR has shown promise in symptom control following amputation. This study demonstrates that symptom control may translate to decreased rates of chronic opiate use. Although limited by small sample size, these results suggest that TMR may have a impact on quality of life for amputee patients by improving symptoms while avoiding significant opioid-related side effects. Continued study is indicated to optimize TMR techniques, patient selection, and determine its long-term efficacy.
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