The similarities between
phantom limb pain and preoperative limb
pain have been noted, and this raises the possibility of modulating the
pain by a preoperative blockade. The aim of this study was to investigate if it was possible to reduce postoperative
phantom limb pain by giving lumbar epidural blockade (LEB) with
bupivacaine and
morphine for 72 h prior to the operation. 25 patients were interviewed about their limb
pain before limb
amputation, and about their
phantom limb pain 7 days, 6 months and 1 year after limb loss. 11 patients, of mean age 77 years (52-93), received an LEB, so that they were
pain-free for 3 days prior to operation. The control group, 14 patients of mean age 73.4 years (63.86), all had preoperative limb
pain. Seven days after operation, 3 patients in the LEB group and 9 patients in the control group had
phantom limb pain (P less than 0.10). After 6 months all patients in the LEB group were
pain-free, whilst 5 patients in the control group had
pain (P less than 0.05). After 1 year, all the patients in the LEB group were still
pain-free, and 3 patients in the control group had
phantom limb pain (P less than 0.20). Preoperative lumbar epidural blockade with
bupivacaine and
morphine reduces the incidence of
phantom limb pain in the first year after operation.