The Use of Prolonged Peripheral Neural Blockade After Lower Extremity Amputation

Borghi, Battista; D'Addabbo, Marco; White, Paul F.; Gallerani, Pina; Toccaceli, Letizia; Raffaeli, William; Tognú, Andrea; Fabbri, Nicola; Mercuri, Mario

doi:10.1213/ane.0b013e3181f4e848

Cited by 166 publications

(89 citation statements)

References 37 publications

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“…These include the possible influence of regional anaesthesia or the timing and role of preemptive analgesia in preventing PLP and SP. Current evidence is not in strong support of any one anaesthetic technique, (10,32,33,(38)(39)(40)(41)(42)(43)(44) and multimodal analgesia supplying good postoperative pain control is likely to provide a greater impact. (45)(46)(47) Psychological factors such as anxiety or depression may affect the onset, course and severity of pain in these patients.…”

Section: Discussionmentioning

confidence: 98%

Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital

Sin¹,

Thong²,

Poon³

2013

SMedJ

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Singapore Med J 2013; 54(2) : 75 O r i g i n a l A r tic le INTRODUCTIONPhantom limb complex is a term used to describe phantom limb sensations (PLS), phantom limb pain (PLP) and/or stump pain (SP).PLS is defined as any sensation, other than pain, in the absent limb. PLP is any painful sensation referred to the absent limb, while SP is pain localised in the stump. These elements often coexist in patients and may be difficult to differentiate.(1,2) Phantom limb complex, which is not an uncommon phenomenon, can be chronic and distressing to patients.Based on the current literature, the reported incidences of PLP vary from 47%-79%.

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Section: Discussionmentioning

confidence: 98%

Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital

Sin¹,

Thong²,

Poon³

2013

SMedJ

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“…5 There is prospective clinical evidence that after upper and lower extremity amputation, continuous brachial plexus, sciatic, and femoral nerve blocks may decrease the incidence or severity of phantom limb pain. 18,19 Whether a continuous paravertebral block reduces phantom breast pain remains uninvestigated. Consequently, we designed and executed this prospective follow-up study of our previously published randomized, triple-masked, placebo-controlled clinical trial involving short-term outcomes 16 to determine whether extending a single-injection paravertebral block with a multiple-day infusion decreases chronic breast pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy.…”

mentioning

confidence: 99%

Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

et al. 2014

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“…Numerous studies have reported on interventions at different points along this altered pathway, from direct and indirect cortical modulation to surgical resection of the distal residual nerve (and at many points in between), yet no accepted guidelines for treatment have emerged (21)(22)(23)(24)(25)(26). Treatment strategies targeting the peripheral nerve, such as catheter placement for infusion of anesthetic postoperatively, peripheral neuromodulation, lidocaine injections, and cryoanalgesia guided by nerve stimulation, have been reported more recently as potentially efficacious (27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

Prologo

Gilliland

Yamada

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose-To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial. Materials and Methods-FromJanuary 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.Results-Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P < .0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P < .0001).Conclusions-Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.Approximately 185,000 amputations are performed each year in the United States, and studies estimate that nearly 3.6 million people will be living with limb loss worldwide by 2050 (1,2). A common complaint among amputees is phantom limb pain (PLP), a phenomenon in which unpleasant sensations, often painful and severe, are perceived to originate from an absent limb. PLP occurs in 50%-80% of amputees, and there is no consistent evidence to support any specific pain control modality or intervention in this setting (1,(3)(4)(5)(6)(7). The objectives of this study were to (a) evaluate the safety and feasibility of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript a separated 2-step procedural methodology consisting of computed tomography (CT)-guided perineural diagnostic injection and cryoablation in the setting of refractory PLP; (b) confirm the reproducibility of treatment response in relation to the findings of previous studies; and (c) derive estimates for key study parameters, such as recruitment rates, potentially confounding variables, and the treatment effect and its variation to inform the planning and design of a larger, parallel-armed, randomized controlled clinical trial investigating the efficacy of cryoablation for the treatment of PLP. MATERIALS AND METHODSThis study was approved by the university institutional review board and complied with the Health Insurance Portability and Accountability Act. The trial was registered before patient enrollment on ClinicalTrials.gov (NCT02366832). SubjectsSubjects were recruited from January 2015 to January 2016 from local vascular surgery, orthopedic surgery, and physical medicine and rehabilitation practices. All patients reported phantom pains and/or unwanted sensations related to a previously amputated upper or lower limb that were refr...

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The Use of Prolonged Peripheral Neural Blockade After Lower Extremity Amputation

Abstract: Use of a prolonged postoperative perineural infusion of ropivacaine 0.5% seems to be an effective therapy for the treatment of phantom limb pain and sensations after lower extremity amputation.

Cited by 166 publications

References 37 publications

Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital

Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital

Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

Percutaneous image-guided cryoablation for the treatment of phantom limb pain in amputees: a pilot study

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