Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade

TLDR

Similarities between phantom limb pain and preoperative limb pain suggest that preoperative blockade might modulate postoperative pain. The study aimed to determine whether a 72‑hour lumbar epidural blockade with bupivacaine and morphine before amputation could reduce postoperative phantom limb pain. Twenty‑five patients were followed, with 11 receiving the blockade and remaining pain‑free for three days pre‑op, while 14 controls had pre‑operative limb pain; pain was assessed at 7 days, 6 months, and 1 year post‑amputation. The blockade group had a markedly lower incidence of phantom limb pain—3 of 11 at 7 days, none at 6 months and 1 year—compared to 9 of 14, 5 of 14, and 3 of 14 in controls, indicating that preoperative lumbar epidural blockade reduces phantom limb pain in the first year.

Abstract

The similarities between phantom limb pain and preoperative limb pain have been noted, and this raises the possibility of modulating the pain by a preoperative blockade. The aim of this study was to investigate if it was possible to reduce postoperative phantom limb pain by giving lumbar epidural blockade (LEB) with bupivacaine and morphine for 72 h prior to the operation. 25 patients were interviewed about their limb pain before limb amputation, and about their phantom limb pain 7 days, 6 months and 1 year after limb loss. 11 patients, of mean age 77 years (52–93), received an LEB, so that they were pain-free for 3 days prior to operation. The control group, 14 patients of mean age 73.4 years (63.86), all had preoperative limb pain. Seven days after operation, 3 patients in the LEB group and 9 patients in the control group had phantom limb pain (P < 0.10). After 6 months all patients in the LEB group were pain-free, whilst 5 patients in the control group had pain (P < 0.05). After 1 year, all the patients in the LEB group were still pain-free, and 3 patients in the control group had phantom limb pain (P < 0.20). Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation.