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 less than 0.10). After 6 months all patients in the LEB group were pain-free, whilst 5 patients in the control group had pain (P less than 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 less than 0.20). Preoperative lumbar epidural blockade with bupivacaine and morphine reduces the incidence of phantom limb pain in the first year after operation.

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In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3-uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4-S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous-oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma-TSH, compared to the other group, which had a significant (P less than 0.05) increase peroperatively. The patients receiving epidural analgesia were pain-free and the normal stress-induced increase in plasma-glucose was abolished. Concerning T3 we found a significant decrease in both groups and a steady level of T4- and T3-uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma-TSH concentration are markedly similar to the effects of other anterior pituitary hormones, i.e. HGH, prolactin and ACTH.