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The Effects of TMR/RPNI on Long Term Narcotic Use in Amputees: An Update
Cristin Coquillard MD, Corinne Wee MD, Sam Boas BS, Tobias Long MD, Kyle Lineberry MD, Joseph Khouri MD
Case Western Reserve/University Hospitals Cleveland Medical Center
2021-02-15
Presenter: Cristin Coquillard
Affidavit:
Cristin Coquillard
Director Name: Edward Davidson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Purpose:
TMR/RPNI is a novel surgery combining the well described technique of targeted muscle reinnervation (TMR), which coapts a sensory or mixed nerve to a motor nerve, with the more recently described regenerative peripheral nerve interface (RPNI), in which the coaptation is insulated with an autologous free muscle graft. In this combined procedure, the aim is that the techniques act synergistically to reduce neuroma and phantom limb pain in amputees. The purpose of this study was to evaluate the effect of TMR/RPNI on opioid consumption after amputation. We hypothesize that TMR/RPNI decreases the use of chronic opioid consumption.
Methods:
We performed a retrospective cohort study including all patients who underwent amputation at a single center from April 2019 to February 2021 with immediate or delayed TMR/RPNI. Data collected included patient demographics, operative details, and pre- and post-operative opioid use. IBM SPSS Version 25 was used to perform statistical analysis.
Results:
23 patients were included in the study. 19 patients had follow-up after 90 days, only one of which (5.3%) still required narcotic pain management after the 90 day period. In comparison to the published rate of 20% chronic opioid use in opioid naïve amputees, our study cohort trended toward chronic opioids at a lower rate, though this did not achieve statistical significance (p=0.34).
Conclusions:
This study demonstrates that the combination of TMR/RPNI may decrease chronic opioid use in amputees, though the study was insufficiently powered. Further study is needed to fully elucidate the potential benefits of TMR/RPNI in amputees.
