Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial.

Abstract

BACKGROUND:

Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up.

METHODS:

A total of 65 patients underwent lower-limb amputation and were assigned to five analgesic regimens: (1) Epi/Epi/Epi patients received perioperative epidural analgesia and epidural anesthesia; (2) PCA/Epi/Epi patients received preoperative intravenous patient-controlled analgesia (PCA), postoperative epidural analgesia, and epidural anesthesia; (3) PCA/Epi/PCA patients received perioperative intravenous PCA and epidural anesthesia; (4) PCA/GA/PCA patients received perioperative intravenous PCA and general anesthesia (GA); (5) controls received conventional analgesia and GA. Epidural analgesia or intravenous PCA started 48 h preoperatively and continued 48 h postoperatively. The results of the visual analog scale and the McGill Pain Questionnaire were recorded perioperatively and at 1 and 6 months.

RESULTS:

At 6 months, median (minimum-maximum) PLP and P values (intervention groups vs. control group) for the visual analog scale were as follows: 0 (0-20) for Epi/Epi/Epi (P = 0.001), 0 (0-42) for PCA/Epi/Epi (P = 0.014), 20 (0-40) for PCA/Epi/PCA (P = 0.532), 0 (0-30) for PCA/GA/PCA (P = 0.008), and 20 (0-58) for controls. The values for the McGill Pain Questionnaire were as follows: 0 (0-7) for Epi/Epi/Epi (P < 0.001), 0 (0-9) for PCA/Epi/Epi (P = 0.003), 6 (0-11) for PCA/Epi/PCA (P = 0.208), 0 (0-9) for PCA/GA/PCA (P = 0.003), and 7 (0-15) for controls. At 6 months, PLP was present in 1 of 13 Epi/Epi/Epi, 4 of 13 PCA/Epi/Epi, and 3 of 13 PCA/GA/PCA patients versus 9 of 12 control patients (P = 0.001, P = 0.027, and P = 0.009, respectively). Residual limb pain at 6 months was insignificant.

CONCLUSIONS:

Optimized epidural analgesia or intravenous PCA, starting 48 h preoperatively and continuing for 48 h postoperatively, decreases PLP at 6 months.

• Authors: Menelaos Karanikolas, Diamanto Aretha, Ioannis Tsolakis, Georgia Monantera, Panagiotis Kiekkas, Spyros Papadoulas, Robert A Swarm, Kriton S Filos
• Journal: Anesthesiology (Anesthesiology) Vol. 114 Issue 5 Pg. 1144-54 (May 2011) ISSN: 1528-1175 [Electronic] United States
• PMID: 21368651 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Aged
• Analgesia, Epidural (methods)
• Analgesia, Patient-Controlled (methods)
• Anesthesia, Epidural
• Anesthesia, General
• Chronic Disease
• Double-Blind Method
• Female
• Follow-Up Studies
• Greece (epidemiology)
• Humans
• Lower Extremity (surgery)
• Male
• Pain Measurement (methods, statistics & numerical data)
• Perioperative Care (methods)
• Phantom Limb (drug therapy, epidemiology)
• Prospective Studies
• Severity of Illness Index