title: The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain.
abstract: We report the efficacy of perioperative infusion of clonidine and bupivacaine for above-knee amputation in a patient with a history of phantom limb pain in the same extremity after a previous below-knee amputation. The patient underwent general anesthesia. Before transection, the sciatic nerve was infiltrated with 0.25% bupivacaine 5 mL and clonidine 50 microg. After the nerve was severed, a 20-gauge epidural catheter was inserted into the nerve sheath and externalized laterally through a separate skin incision. Before closure, 0.25% bupivacaine 10 mL and clonidine 50 microg was injected, and 0.1% bupivacaine and clonidine two microg/mL was infused at 10 mL/h for the first 96 hours postoperatively. There were no incidents of hypotension, bradycardia, or sedation during the infusion period. The mean postoperative pain score (from 0 to 10) for 96 hours was 1.2 +/- 0.7. The patient required a total of 10 mg of oxycodone postoperatively. The patient did not report either stump or phantom pain for 12 months after surgery.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Madabhushi
authors.forename: Scott S
authors.initials: SS
authors.lastname: Reuben
authors.forename: Robert B
authors.initials: RB
authors.lastname: Steinberg
authors.forename: John
authors.initials: J
authors.lastname: Adesioye
mesh_terms: D000759:Adjuvants, Anesthesia; D000369:Aged, 80 and over; D000672:Amputation Stumps / Q000601:surgery; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D003000:Clonidine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control*; D010591:Phantom Limb / Q000517:prevention & control*
chemical_list: D000759:Adjuvants, Anesthesia; D000700:Analgesics; D003000:Clonidine; D002045:Bupivacaine