title: Treatment of pain in children after limb-sparing surgery: an institution's 26-year experience.
abstract: A significant proportion of patients report long-term pain that is ≥5 on a 0-10 intensity scale after limb-sparing surgery for malignancies of the long bones. Patients experience several distinct types of pain after limb-sparing surgery which constitute a complex clinical entity. This retrospective study examined 26 years of experience in a pediatric institution (1981-2007) in pain management as long as 6 months after limb-sparing surgery and reviewed the historical evolution of pain interventions. One hundred fifty patients underwent 151 limb-salvage surgeries for bone cancer of the extremities in this series. Pain treatment increased progressively in complexity. Therapies included opioids, nonsteroidal antiinflammatory drugs, acetaminophen-opioid combinations, postoperative continuous epidural infusion, anticonvulsants and tricyclic antidepressants for neuropathic pain, local anesthetic wound catheters, and continuous peripheral nerve block catheters. Management of pain after limb-sparing surgery has evolved over the 26 years of this review. It currently relies on multiple "layers" of pharmacologic and nonpharmacologic strategies to address the complex mixed nociceptive and neuropathic mechanisms of pain in this patient population.
authors.affiliation: Division of Anesthesia and Pain Management Service, Division of Patient Care Services, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. doralina.anghelescu@stjude.org
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.forename: Linda L
authors.initials: LL
authors.lastname: Oakes
authors.forename: Gisele M
authors.initials: GM
authors.lastname: Hankins
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D012516:Osteosarcoma / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D000082:Acetaminophen; D008691:Methadone