Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade.
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.
Department of Orthopaedic Surgery, Randers Central Hospital, DK-8900 RandersDenmark Department of Anaesthesiology, Randers Central Hospital, DK-8900 RandersDenmark.
Søren
S
Bach
Morten F
MF
Noreng
Niels U
NU
Tjéllden
D000368:Aged; D000672:Amputation Stumps / Q000503:physiopathology; D004824:Epidural Space; D006801:Humans; D008161:Lumbosacral Region; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000517:prevention & control*; D010591:Phantom Limb / Q000503:physiopathology*; D011300:Preoperative Care; D012677:Sensation; D013997:Time Factors