An anesthetic approach to amputation and pain syndromes.
Primary anesthetic intervention is a very effective modality in the prevention of phantom limb pain. The first phase is reduction of the preamputation pain by epidural or intrathecal infusion with local anesthetic and opioid. The catheter can be used for the operative phase, along with an intraneural catheter placement, if necessary. The epidural/intrathecal infusion can continue for 2 to 3 days and eventually be converted to a pharmacologic regimen. This can include opioids for surgical pain, along with a tricyclic antidepressant and an alpha-2 adrenergic agonist. If phantom sensation or phantom limb pain develops, gabapentin (Neurontin) is an effective agent for neuropathic pain. Surgical ablative therapy consists of cordotomy, rhizotomy, dorsal root entry zone lesion, or thalamotomy. Other modalities include dorsal column stimulation to facilitate inhibitory descending pathways. An intrathecal delivery system can be placed to infuse clonidine, local anesthetic, and opioid. For pain management, implantable intrathecal delivery systems may become an important tool for the future management of postamputation pain syndrome.
Danshaw
C B
CB
Department of Anesthesiology and Pain Management, HealthSouth Cityview Hospital, Fort Worth, Texas, USA.
D000671:Amputation, Surgical / Q000009:adverse effects* / Q000379:methods; D000698:Analgesia / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D003714:Denervation / Q000379:methods*; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D010591:Phantom Limb / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods