Perioperative Pain Management Strategies for Amputation: A Topical Review.

Published

Journal Article (Review)

To review acute pain management strategies in patients undergoing amputation with consideration of preoperative patient factors, pharmacologic/interventional modalities, and multidisciplinary care models to alleviate suffering in the immediate post-amputation setting.Regardless of surgical indication, patients undergoing amputation suffer from significant residual limb pain and phantom limb pain in the acute postoperative phase. Most studies have primarily focused on strategies to prevent persistent pain with inclusion of immediate postoperative outcomes as secondary measures. Pharmacologic agents, including gabapentin, ketamine, and calcitonin, and interventional modalities such as neuraxial and perineural catheters, have been examined in the perioperative period.Focused Literature Review.Pharmacologic agents (gabapentin, ketamine, calcitonin) have not shown consistent efficacy. Neuraxial analgesia has demonstrated both an opioid sparing and analgesic benefit while results have been mixed regarding perineural catheters in the immediate post-amputation setting. However, several early studies of perineural catheters employed sub-optimal techniques (distal surgical placement), and prolonged use of perineural catheters may provide a sustained benefit. Regardless of analgesic technique, a multidisciplinary approach is necessary for optimal care.Patient-tailored analgesic regimens utilizing catheter-based techniques are essential in the acute post-amputation phase and should be implemented in all patients undergoing amputation. Future research should focus on improved measurement of acute pain and comparisons of effective analgesic regimens instead of single techniques.

Full Text

Duke Authors

Cited Authors

  • Kent, ML; Hsia, H-LJ; Van de Ven, TJ; Buchheit, TE

Published Date

  • March 2017

Published In

Volume / Issue

  • 18 / 3

Start / End Page

  • 504 - 519

PubMed ID

  • 27402960

Pubmed Central ID

  • 27402960

Electronic International Standard Serial Number (EISSN)

  • 1526-4637

International Standard Serial Number (ISSN)

  • 1526-2375

Digital Object Identifier (DOI)

  • 10.1093/pm/pnw110

Language

  • eng