EFFICACY OF TARGETED MUSCLE REINNERVATION IN MITIGATING NEUROPATHIC PAIN AND NEUROMA FORMATION IN AMPUTEES. A RANDOMIZED CONTROLLED TRIAL. drabhinav1975@gmail.com

 

EFFICACY OF TARGETED MUSCLE REINNERVATION IN MITIGATING NEUROPATHIC PAIN AND NEUROMA FORMATION IN AMPUTEES. A RANDOMIZED CONTROLLED TRIAL.

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India

Oral only

Post amputation pain (PAP) and neuroma formation in amputees are major causes of morbidity. Preemptive surgical management of the severed nerves has shown to be effective. This study examines the role of Targeted Muscle Reinnervation (TMR) in preventing and treating PLP and neuroma formation in amputees.

A Randomized Controlled Trial (RCT) in patients with above-knee amputation (AKA) following trauma was conducted at a level-I trauma center. 97 patients were enrolled in the study. The patients were randomized into two groups, i.e., group A with TMR (intervention) and group B with conventional stump formation (control). The patients were assessed for pain using pain scores; Numerical Rating Score (NRS) and McGill Pain Questionnaire (MPQ) and evaluation of neuroma formation was done using high-frequency ultrasonography. The patients were followed up till 12 weeks of amputation. Both per-protocol analysis and intention-to-treat analysis (IIT) were done.

The difference of the mean NRS of the residual limb pain (1.8 vs 3.3) and phantom limb pain (1.2 vs 2.6) was statistically significant between the two groups (p-value: 0.001). Similar findings were seen when MPQ was compared (p<0.01). The neuroma size measured using ultrasound at 12 weeks was statistically significant between the groups (p<0.05).

The preemptive surgical intervention of amputated nerve at the time of amputation by TMR techniques significantly reduces the neuropathic pain and the neuroma formation.