# The Perioperative Challenges of Major Lower Extremity Amputation and the Impact of Regional Anesthesia on Morbidity, Mortality, and Pain Management: A Narrative Review

## TL;DR

This review discusses the challenges of major lower extremity amputation and how regional anesthesia can improve outcomes like pain management and recovery.

## Contribution

The paper provides a critical synthesis of evidence on regional anesthesia's impact on morbidity, mortality, and pain after amputation.

## Key findings

- Regional anesthesia offers physiological benefits over general anesthesia for high-risk patients.
- There is a need for prospective trials to validate the efficacy of regional anesthesia in reducing adverse outcomes.
- Regional anesthesia may reduce hospital stays and healthcare costs while improving patient satisfaction.

## Abstract

Limb amputation can impose severe burdens on the individual and society. Regardless of the underlying cause of amputation, pain management is challenging and may impact patients’ recovery and quality of life. Individuals undergoing major lower extremity amputation (MLEA) face significant perioperative risk. Therefore, anesthesiologists must meticulously customize their anesthetic approach. Regional anesthesia (RA) provides numerous physiological advantages over general anesthesia (GA) and is essential for pain management in orthopedic surgeries, standing as an excellent anesthesia method for high-risk patients and being fundamental in multimodal analgesia. This narrative review is an attempt to enhance understanding of different pain phenomena following limb amputation and to provide a critical synthesis of the existing evidence concerning the efficacy and impact of RA on morbidity, mortality, and pain management following MLEA, aiming to shed light on areas that have not received enough attention within these aspects and subsequently serve as a guide for future research. Despite the persistent controversy regarding the comparative mortality rates associated with RA versus alternative anesthetic methods for MLEA, several studies praise their efficacy in pain management and in mitigating adverse perioperative outcomes. Given that much of this data originates from retrospective studies, randomized multicenter prospective trials remain essential to validate their actual efficacy. A comprehensive analysis of the impact of RA on healthcare costs and resources related to MLEA is necessary to determine its correlation with cost reduction, decreased hospital stays, improved resource allocation, and increased patient satisfaction.