Background and Objectives Reports about the efficacy of local anesthetic perfusion of nerve stumps following lower extremity amputation are conflicting. We report our experience with this technique following amputation of the upper extremity.
Methods Six consecutive patients undergoing proximal upper extremity amputations (four forequarter amputations and two shoulder disarticulations) for malignancy were prospectively observed. In all patients, catheters were placed within the amputated nerve sheaths at the conclusion of the procedure. Bupivacaine, 0.25%, was administered through each catheter as a bolus and then as a continuous infusion for at least 72 hours after surgery. Narcotic usage, level of pain as reported verbally, and presence of phantom limb pain during the infusion were recorded. For at least 1 year after operation, data were gathered on the presence of phantom limb pain and its intensity during each follow-up visit.
Results Complete analgesia was achieved in all patients by postoperative day 2. Narcotic usage was low. Three of the six patients reported phantom limb pain during follow-up evaluation.
Conclusions Continuous local anesthetic perfusion of amputated nerves via a catheter placed under direct vision provided excellent postoperative analgesia. The incidence of phantom limb pain for cancer patients did not differ from that previously reported but was easily managed pharmacologically. The technique may also be efficacious for traumatic amputations.
- postoperative analgesia
- nerve sheath catheters
- phantom limb
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Presented in part at the annual meeting of the American Academy of Orthopaedic Surgeons, Atlanta, February 1996, and the American Society of Regional Anesthesia, Orlando, March 29-April 2, 1995.