Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Aimed to identify whether the use of peripheral nerve blockade (PNB) pre-traumatic limb amputation reduced long-term opiate requirements. Evidence suggests that epidural anaesthesia may reduce post-surgical pain. Data to show the longer-term effects PNB has on opiate use is limited.

Methods This was a retrospective observational study. Patients who underwent orthopaedic limb amputation between 21/07/2020 and 19/10/23 were included. Anaesthetic charts, notes and community prescriptions were reviewed to assess pre-admission, discharge, and present opiate prescription.

Results 69 patients identified. 72% had a PNB (single shot or infusion), 28% did not. 42/69 (61%) patients were prescribed an opiate prior to admission for amputation.

Conclusions This observational study did not show that PNB pre-amputation reduces opiate prescription at or beyond discharge. The data highlights that fewer (62% vs 81%) patients who were on opiates pre-admission were given a PNB compared to those who were not prescribed opiates pre-admission. In those who had a PNB, 88% of patients taking opiates pre-admission were discharged with opiates compared to 63% of those not on a pre-admission opiate. Results suggest that pre-admission opiate use may not always be used as a considering factor for PNB in current practice. Limitations to this study include a small cohort size, unrecorded indications for opiate prescriptions and unclear reasons as to why patients did not receive PNB. Further work to establish whether PNB reduces long-term opiate use is needed. A study where patients (PNB vs non-PNB) are monitored at set time intervals post amputation to assess change in opiate requirement would be useful.