Propofol and Ketamine for Targeted Muscle Reinnervation after Limb Amputation: A Case Report

Abstract

Surgical procedures that require neuromuscular monitoring

present unique challenges to the anesthesia provider. Specific

patient characteristics such as phantom limb pain or chronic

opioid use can further complicate perioperative management. The

following case presentation illustrates the anesthetic management

of a patient exhibiting these complications who presented for

surgery with a prior transhumeral amputation. Nerve reassignment

was planned with the eventual goal of a thought-controlled

prosthesis. Anesthesia was maintained by the combination of

propofol and ketamine along with adjuncts such as hydromorphone,

midazolam and glycopyrrolate. These drugs and similar

anesthetic combinations cause minimal changes to neurophysiologic

monitoring while decreasing various types of neuropathic

pain and provide an effective alternative for treating patients with

chronic pain.