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

  • Angela Hupman, SRNA Student Registered Nurse Anesthetist Georgetown University
  • Ladan Eshkevari, PhD, CRNA Assistant Director & Professor Georgetown University Nurse Anesthesia Program


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.


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How to Cite
HUPMAN, SRNA, Angela; ESHKEVARI, PHD, CRNA, Ladan. Propofol and Ketamine for Targeted Muscle Reinnervation after Limb Amputation: A Case Report. Anesthesia eJournal, [S.l.], v. 1, n. 1, jan. 2013. ISSN 2333-2611. Available at: <>. Date accessed: 09 dec. 2021.


propofol, ketamine, TIVA, targeted muscle reinnervation, phantom limb pain