Jones, Harri G., Nielsen, Rhiannon, Abdelgafar, Katrin, Pemmasani, Praveena, Gwilym, Brenig, Pallmann, Philip  ORCID: https://orcid.org/0000-0001-8274-9696, Forget, Patrice, Twine, Christopher P. and Bosanquet, David C.
2026.
Peri-operative percutaneous nerve blocks and catheters in major lower limb amputation: a systematic review with meta-analysis.
European Journal of Vascular and Endovascular Surgery
10.1016/j.ejvs.2026.09.013
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Abstract
Objective Major lower limb amputation is associated with substantial post-operative pain. While surgically placed nerve catheters are commonly used, the role of peri-operative percutaneous peripheral nerve blocks (PNBs) and percutaneous peripheral nerve catheters (PNCs) for anaesthesia and or post-operative analgesia remains incompletely defined. This systematic review synthesised the published evidence on post-operative outcomes associated with PNBs and PNCs in patients undergoing major lower limb amputation. Data Sources MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched (1 January 2005 to 1 March 2025). Methods A systematic review was conducted in accordance with PRISMA guidelines and was prospectively registered with PROSPERO (CRD420251233062). Exploratory meta-analyses of post-operative acute pain, opioid requirements, phantom limb pain, and mortality were undertaken, with PNBs and PNCs grouped together as a single peripheral nerve intervention. GRADE criteria were used to express certainty of pooled results. Results Forty-one studies involving 913 patients undergoing PNB and or PNC were included, comprising randomised controlled trials (n = 4), observational studies (n = 10), and case series or reports (n = 27). PNBs and PNCs were most commonly used as an adjunct to general anaesthesia (54.6%, 95% confidence interval [CI] 51.2 – 58.0%), followed by sole anaesthesia (22.9%, 95% CI 20.2 – 25.9%) and adjunct use with sedation (22.5%, 95% CI 19.7 – 25.4%), and were almost always performed pre-operatively. Compared with general anaesthesia alone, PNB/PNC ± general anaesthesia use was associated with lower post-operative 0 – 10 pain scores (mean difference [MD] –1.70, 95% CI –2.48 – –0.92; p < .001; I2 = 85.4%; GRADE, very low) and reduced post-operative opioid requirements (MD –18.28 mg, 95% CI –31.02 – –5.54; p = .005; I2 = 90.51%; GRADE, very low). Findings were maintained in subgroup analyses restricted to PNB/PNC use as an adjunct to general anaesthesia, for both acute pain scores and post-operative morphine requirements. PNB or PNC use did not impact long term pain. Complications were rare. Conclusion PNB/PNC use may improve early pain outcomes after major lower limb amputation, without impacting longer term phantom limb pain.
| Item Type: | Article |
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| Date Type: | Published Online |
| Status: | In Press |
| Schools: | Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR) |
| Publisher: | Elsevier |
| ISSN: | 1078-5884 |
| Date of Acceptance: | 4 September 2026 |
| Last Modified: | 15 Sep 2026 10:00 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/189603 |
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