Options were discussed with Mr P. Different opioids were suggested but he declined, convinced that they would not help. Anti-neuropathic agents were considered but his co-morbidities meant amitriptyline, duloxetine, gabapentin and pregabalin were relatively contraindicated. He stated that the gabapentin he received initially had not been beneficial. He was unkeen to try any of these as he was certain that they would not help. He remained committed to the belief that surgery was the only answer.
A multidisciplinary team meeting was held and surgical options, including amputation, were considered. It was decided to perform diagnostic (adductor canal) and sciatic (popliteal) nerve blocks as a precursor to inserting nerve infusion catheters, although it was acknowledged this was a short-term plan.
Mr P gave his consent for this plan. The nerve blocks were performed using bupivacaine. Shortly after the blocks, Mr P reported his pain score of 10/10 had fallen to 0/10. His pain score remained at 0/10 until 4 days after the blocks when it increased to 2/10. He considered this pain acceptable and much better than his pain prior to the fall. His pain score remained at 2/10 until he was discharged 7 days after the blocks. The orthopaedic team attributed his improvement to the placebo effect.
