No penalty for blocking: Preoperative nerve blocks do not prevent motor nerve stimulation during TMR.

Abstract

The timing of nerve blocks for amputation surgery with immediate targeted muscle reinnervation (TMR) has been disputed. Traditional practices often defer nerve blocks until post-amputation, fearing interference with motor nerve target identification for TMR. Here, we present a case series demonstrating that pre-amputation regional nerve blocks do not prevent the identification of motor nerve targets. Retrospective data from 26 patients undergoing amputation with TMR and pre-operative nerve blocks were analyzed. The results in Tables 1 and 2 showcase successful TMR transfers across various amputation types, with preserved nerve stimulation for TMR despite preoperative regional anesthesia. The findings are supported by existing literature on regional anesthesia's differential blockage mechanism, emphasizing its compatibility with TMR. Moreover, pre-operative nerve blocks have shown efficacy in pain reduction and postoperative complication mitigation, possibly enhancing overall surgical outcomes. This study underscores the feasibility and benefits of integrating pre-amputation nerve blocks with TMR, offering a comprehensive approach to pain management in limb amputation. This technique optimizes both short- and long-term pain control.