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"TMRPNI" to Combat Chronic Opioid Use in Amputees

Corinne Wee MD, David E. Kurlander MD, Sam Boas BS, Tobias Long MD, Kyle Lineberry MD, Joseph Khouri MD
Case Western Reserve University

Presenter: Corinne Wee

I certify that this represents the original work of the resident.

Director Name: Anand Kumar MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

PURPOSE: "TMRpni" is a novel nerve management strategy that leverages beneficial elements of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) techniques. TMRpni involves coaptation of a sensory or mixed sensory/motor nerve to a nearby motor nerve branch as is performed in traditional TMR surgery, in addition to insulating the coaptation with an autologous free muscle graft as in RPNI. This study aims to evaluate the effect of TMRpni on opioid consumption after amputation. We hypothesize that TMRPNI decreases chronic opioid consumption in amputees.

METHODS: This is a retrospective cohort study of all patients undergoing amputation with immediate or delayed TMRPNI at a single academic center from April 2019 through January 2020. Data collected included demographics, intraoperative details, and pre- and post-operative opioid use. Statistical analysis was performed using IBM SPSS Version 25 and included Fisher's Exact Test.

RESULTS: Fourteen patients underwent TMRPNI during this time period. Two patients were excluded due to documented preoperative opioid use. Six patients had follow-up after 90 days; none (0%) of these patients still required narcotic pain medication. 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 did not reach statistical significance (p = 0.26).

CONCLUSIONS: This study demonstrates that TMRpni may translate to decreased rates of chronic opiate use, despite being underpowered in its current phase. Continued study is indicated to optimize TMRPNI techniques, patient selection, and determine its long-term efficacy.

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