Targeted muscle reinnervation for managing limb amputation pain

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 13 sources, which was discussed by the committee. The evidence included 2 systematic reviews, 1 randomised controlled trial (also included in the systematic reviews), 1 retrospective propensity score-matched study, 2 prospective cohort studies, 1 prospective case series (also included in the systematic review) and 6 retrospective case series or cohort studies (1 of which was also included in the systematic review). It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: reduction in pain and improved quality of life.

The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection and reoperation.

Patient commentary was sought but none was received.

The committee was told that the procedure may have different benefits in upper and lower limbs. It may help use of a prosthesis in upper limbs.

The committee was told that the procedure may unmask a neuroma in another nerve and another operation may be needed.

The committee was told that this procedure should be done by surgeons experienced in nerve surgery.