Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees.
BACKGROUND
Hyperexcitability of N-methyl-d-aspartate acid (NMDA) receptors may play an important role in the development of phantom limb pain (PLP).


OBJECTIVE
To investigate whether early treatment with the NMDA antagonist memantine attenuates phantom pain memory formation in traumatic amputees.


METHODS
In a randomized, double-blind, controlled trial 19 patients with acute traumatic amputation of the upper extremity were investigated. All patients received postoperative analgesia by continuous brachial plexus anesthesia (ropivacaine 0.375% 5 ml/h) for at least 7 days. In addition, the patients received either memantine (20-30 mg daily, n=10) or placebo (n=9) for 4 weeks.


RESULTS
Memantine treatment reduced the number of requested ropivacacine bolus injections during the first week and resulted in a significant decrease of PLP prevalence and intensity at 4 weeks and 6 months follow up, but not at 12 months follow up.


CONCLUSIONS
We conclude that memantine can reduce intensity of phantom limb pain and might also prevent the development of PLP. However, despite the very early begin of treatment; no long-term effect on established PLP was evident.
Schley
M
M
Department of Anaesthesiology and Intensive Care Medicine, Experimental Pain Research/Pain Centre, University of Heidelberg, Faculty of Clinical Medicine, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. marcus.schley@anaes.ma.uni-heidelberg.de
Topfner
S
S
Wiech
K
K
Schaller
H E
HE
Konrad
C J
CJ
Schmelz
M
M
Birbaumer
N
N
D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000673:Amputation, Traumatic / Q000150:complications* / Q000503:physiopathology; D000779:Anesthetics, Local / Q000008:administration & dosage; D001917:Brachial Plexus / Q000187:drug effects* / Q000502:physiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D008297:Male; D008559:Memantine / Q000008:administration & dosage*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009619:Nociceptors / Q000187:drug effects / Q000378:metabolism; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D010591:Phantom Limb / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors / Q000378:metabolism; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D018691:Excitatory Amino Acid Antagonists; D016194:Receptors, N-Methyl-D-Aspartate; D018698:Glutamic Acid; D000077212:Ropivacaine; D008559:Memantine