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Cited by 202Anesthesia and Pain ManagementPain Management and TreatmentPain Management and Opioid Use

Optimized Perioperative Analgesia Reduces Chronic Phantom Limb Pain Intensity, Prevalence, and Frequency: A Prospective, Randomized, Clinical Trial

Karanikolas, Menelaos, Aretha, Diamanto, Tsolakis, Ioannis, Monantera, Georgia, Kiekkas, Panagiotis, Papadoulas, Spyros, Swarm, Robert A., Filos, Kriton S.·2011·Anesthesiology
DOI 10.1097/aln.0b013e31820fc7d2
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Abstract

Background: Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up. Methods: A total of 65 patients underwent lower-limb amputation and were assigned to five analgesic regimens: (1) Epi/Epi/Epi patients received perioperative epidural analgesia and epidural anesthesia; (2) PCA/Epi/Epi patients received preoperative intravenous patient-controlled analgesia (PCA), postoperative epidural analgesia, and epidural anesthesia; (3) PCA/Epi/PCA patients received perioperative intravenous PCA and epidural anesthesia; (4) PCA/GA/PCA patients received perioperative intravenous PCA and general anesthesia (GA); (5) controls received conventional analgesia and GA. Epidural analgesia or intravenous PCA started 48 h preoperatively and continued 48 h postoperatively. The results of the visual analog scale and the McGill Pain Questionnaire were recorded perioperatively and at 1 and 6 months. Results: At 6 months, median (minimum-maximum) PLP and P values (intervention groups vs. control group) for the visual analog scale were as follows: 0 (0-20) for Epi/Epi/Epi (P = 0.001), 0 (0-42) for PCA/Epi/Epi (P = 0.014), 20 (0-40) for PCA/Epi/PCA (P = 0.532), 0 (0-30) for PCA/GA/PCA (P = 0.008), and 20 (0-58) for controls. The values for the McGill Pain Questionnaire were as follows: 0 (0-7) for Epi/Epi/Epi (P < 0.001), 0 (0-9) for PCA/Epi/Epi (P = 0.003), 6 (0-11) for PCA/Epi/PCA (P = 0.208), 0 (0-9) for PCA/GA/PCA (P = 0.003), and 7 (0-15) for controls. At 6 months, PLP was present in 1 of 13 Epi/Epi/Epi, 4 of 13 PCA/Epi/Epi, and 3 of 13 PCA/GA/PCA patients versus 9 of 12 control patients (P = 0.001, P = 0.027, and P = 0.009, respectively). Residual limb pain at 6 months was insignificant. Conclusions: Optimized epidural analgesia or intravenous PCA, starting 48 h preoperatively and continuing for 48 h postoperatively, decreases PLP at 6 months.

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  • In a study of 65 patients undergoing lower limb amputation, optimized perioperative epidural analgesia or intravenous patient-controlled analgesia started 48 hours preoperatively and continued 48 hours postoperatively significantly reduced the incidence of phantom limb pain at 6 months compared with conventional analgesia and general anesthesia.

    “In a study by Karanikolas et al. of 65 patients who underwent lower limb amputation, the incidence of phantom limb pain after 6 months decreased significantly more following the use of an optimized perioperative epidural analgesia, or if an intravenous patient-controlled analgesia was started 48 hours preoperatively and continued for 48 hours postoperatively, compared with patients who received co”

    From Chronic postsurgical pain: current evidence for prevention and management (2018) · cites this paper as [22]

  • Phantom pain has been found to be similar when either PCA with fentanyl or an epidural infusion with bupivacaine was started 48 hours preoperatively and continued for 48 hours postoperatively.

    “Phantom pain has also been found to be similar when either PCA with fentanyl or an epidural infusion with bupivacaine was started 48 hours preoperatively and continued for 48 hours postoperatively [22].”

    From Chronic postsurgical pain: current evidence for prevention and management (2018) · cites this paper as [22]

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Authors
Karanikolas, M., Aretha, D., Tsolakis, I., Monantera, G., Kiekkas, P., Papadoulas, S., Swarm, R. A., & Filos, K. S.
Affiliations
  • Assistant Professor.
  • Consultant.
  • Professor.
  • Registered Nurse, General Hospital of Chest Diseases, Patras, Greece.
  • University of Patras (GR)
  • Washington University in St. Louis (US)
  • Professor, Department of Anaesthesiology and Critical Care Medicine.
ORCID
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-05-01
Volume
114
Issue
5
Pages
1144-1154
ISSN
0003-3022 (ISSN-L)
DOI
10.1097/aln.0b013e31820fc7d2
OpenAlex
W2139293286
Cited by
202
References
39
Citations by year
2026: 6 · 2025: 8 · 2024: 8 · 2023: 13 · 2022: 8 · 2021: 11 · 2020: 16 · 2019: 11 · 2018: 14 · 2017: 19 · 2016: 11 · 2015: 9 · 2014: 20 · 2013: 19 · 2012: 19
FWCI
22.11
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
phantom limb pain, perioperative analgesia, epidural analgesia, patient-controlled analgesia, lower limb amputation, postoperative pain, general anesthesia, pain intensity, pain frequency, McGill Pain Questionnaire, visual analogue scale
MeSH terms
Aged, Anesthesia, Epidural, Anesthesia, General, Chronic Disease, Double-Blind Method, Female, Follow-Up Studies, Greece, Humans, Male, Pain Measurement, Phantom Limb, Prospective Studies, Severity of Illness Index, Analgesia, Epidural, Analgesia, Patient-Controlled, Perioperative Care, Lower Extremity

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