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

Surgical procedures that require neuromuscular monitoringpresent unique challenges to the anesthesia provider. Specificpatient characteristics such as phantom limb pain or chronicopioid use can further complicate perioperative management. Thefollowing case presentation illustrates the anesthetic managementof a patient exhibiting these complications who presented forsurgery with a prior transhumeral amputation. Nerve reassignmentwas planned with the eventual goal of a thought-controlledprosthesis. Anesthesia was maintained by the combination ofpropofol and ketamine along with adjuncts such as hydromorphone,midazolam and glycopyrrolate. These drugs and similaranesthetic combinations cause minimal changes to neurophysiologicmonitoring while decreasing various types of neuropathicpain and provide an effective alternative for treating patients withchronic pain