A Retrospective Trial Comparing the Effects of Different Anesthetic Techniques on Phantom Pain After Lower Limb Amputation

Şahin, Sevtap Hekimoğlu; Çolak, Alkın; Arar, Cavidan; Tutunculer, Ebru; Süt, Necdet; Yılmaz, Barış; Birtane, Murat

doi:10.1016/j.curtheres.2011.06.001

Cited by 21 publications

(18 citation statements)

References 20 publications

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“…Prolongation of motor block by α2 adrenoreceptor agonists might be due to impairment of excitatory amino acids release from spinal interneuron [10] . Administration of intrathecal α2receptor agonists had antinociceptive effects for both somatic and visceral pain [1] .…”

Section: Discussionmentioning

confidence: 99%

“…The sensory was presented in table (1) and there was no significant difference between BD, BF and B groups in the highest level of block reached. Block regression was significantly slower in BD when compared to BF or B groups.…”

Section: A Total Of 90 Patients Were Included and Classified Into Thrmentioning

confidence: 92%

“…Multiple pathologic processes developed after lower limb amputation surgery such as pain of phantom limb and stump. The incidence of developing phantom pain and stump pain varying from 49% to 83% in various trials [1] . Phantom pain is a neuropathic pain, tingling or sharp throbbing, arising from a part of the body which is no longer there.…”

Section: Introductionmentioning

confidence: 99%

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Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain

Fekry¹,

Sharf

Kandil³

et al. 2019

International Journal of Medical Arts

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Background: In neuroaxial anesthesia, there was many adjuvants used with the purpose of increasing anesthesia duration and reduction of postoperative analgesia. Objective: comparison between dexmedetomidine and fentanyl when added to 0.5% hyperbaric bupivacaine, for lower limb amputation on early stump and phantom pain after spinal anesthesia. Patients and Methods: Ninety patient arranged for lower limb amputation surgery were randomly allocated into three groups (each 30 patients). Each patient received 2 ml of hyperbaric bupivacaine (0.5%) plus 0.5 ml normal saline in control group (Group B) or 5µ dexmedetomidine diluted in 0.5 ml normal saline in BD group or 25 µ fentanyl diluted in 0.5 ml normal saline in BF group. Anesthesia, analgesia, sedation, hemodynamic changes, adverse effects and post-operative pain up to one month were recorded. Results: The studied groups showed no significant differences regarding demographic characteristics and hemodynamic (heart rate and mean arterial pressure). Patients in group BD had significant increase of sensory and motor block time compared to BF B groups. Postoperatively, there was a significant decrease of pain in BD group in the first 24 hours when compared to control or BF group. The postoperative mean total consumption of analgesics during the first day was significantly decreased in BD when compared to BF and control groups. Conclusions: dexmedetomidine (5μg) represents a good alternative to fentanyl (25μg) as a spinal adjuvant to bupivacaine in surgery for the lower limb.

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Section: Discussionmentioning

confidence: 99%

Section: A Total Of 90 Patients Were Included and Classified Into Thrmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain

Fekry¹,

Sharf

Kandil³

et al. 2019

International Journal of Medical Arts

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“…One of the pre-emptive techniques involves providing a continuous nerve blockade in the perioperative and postoperative period in an attempt to prevent the occurrence of PLP. There is conflicting evidence on the use of continuous epidural anesthesia in the prevention of PLP with some studies showing a lower incidence of PLP and others showing no difference in the incidence, although it does appear that perioperative pain control, in general, is important in attempting to prevent the development of PLP [24][25][26]. The literature on continuous perioperative and postoperative peripheral nerve block is similar to epidural anesthesia again with conflicting results in multiple small studies [24,25,27].…”

Section: Interventional Therapiesmentioning

confidence: 94%

Advances in the Treatment of Phantom Limb Pain

Hommer

McCallin

Goff

2014

Curr Phys Med Rehabil Rep

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Phantom limb pain (PLP) continues to place a significant emotional and physical burden on amputees and remains a challenge for those treating amputees. Despite advances in psychological, pharmacologic, and interventional therapies, treatment modalities and research results show promise, but there is no evidence to highly recommend any particular treatment. This review concludes that the best treatment approach is a measured and diligent trial of multiple modes of treatment. As researchers forge forward toward definitively establishing etiologies, focused treatment options may become available. Until then, PLP is an area that calls for intense research and which will continue to challenge the clinician caring for the amputee population.

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“…We relay our focus on peripheral mechanisms as they come with more supporting evidence [4]. Neuraxial anesthesia and peripheral nerve blocks were proven to decrease the severity and the frequency of PLP postoperatively [58]. Anesthetizing the residual limb by local anesthetic injections is reported to attenuate PLP for weeks [59][60][61].…”

Section: Scope and Rationalementioning

confidence: 99%

Role of Potassium Ions Quantum Tunneling in the Pathophysiology of Phantom Limb Pain

et al. 2020

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(1) Background: multiple theories were proposed to explain the phenomenon of phantom limb pain (PLP). Nevertheless, the phenomenon is still shrouded in mystery. The aim of this study is to explore the phenomenon from a new perspective, where quantum tunneling of ions, a promising field in medical practice, might play a major role. (2) Methods: investigators designed a quantum mathematical model based on the Schrödinger equation to examine the probability of potassium ions quantum tunneling through closed membrane potassium channels to the inside of phantom axons, leading to the generation of action potential. (3) Results: the model suggests that the probability of action potential induction at a certain region of the membrane of phantom neurons, when a neuron of the stump area is stimulated over 1 mm2 surface area of the membrane available for tunneling is 1.04 × 10−2. Furthermore, upon considering two probabilities of potassium channelopathies, one that decreased the energy of the barrier by 25% and another one by 50%, the tunneling probability became 1.22 × 10−8 and 3.86 × 10−4, respectively. (4) Conclusion: quantum models of potassium ions can provide a reliable theoretical hypothesis to unveil part of the ambiguity behind PLP.

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A Retrospective Trial Comparing the Effects of Different Anesthetic Techniques on Phantom Pain After Lower Limb Amputation

Cited by 21 publications

References 20 publications

Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain

Spinal Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for lower Limb Amputation Surgery. Effects on Early Stump and Phantom Pain

Advances in the Treatment of Phantom Limb Pain

Role of Potassium Ions Quantum Tunneling in the Pathophysiology of Phantom Limb Pain

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