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Abstract
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Background and Aims Phantom Limb Pain (PLP) is a challenge in pacients with amputation surgery; between 50-80% of patients develop PLP after surgery, once it gas appeared requieres a complex managemente with poor pain control, hence recommendations go towards prevention.
Methods 87 years old man ASA IV in hemodialysis and Clostridium difficile bacteremia, present a non-revascularizable chronic lower limb ischemia, a supracondylar amputation is proposed. A general anesthesia with laryngeal mask is performed and for analgesia: Femoral Nerve Block with Levobupivacaine 0.25% 15 ml. Ultrasound- Guided Femoral Nerve Catheter is placed with Levobupivacaine 0.125% 5 ml/hour infusion. Chemical neurolysis of stump nerves. NSAID (Paracetamol + Dexketoprofen)
Results The patient did not requiere rescue analgesics after surgery and VAS was kept under 3 until he left PACU.
Conclusions Literature supports the use of neuroaxial techniques to prevent PLP, but in this case we declined this approach having in mind the patient comorbilities. Chemical neurolysis of stump nerves and femoral nerve block take in account the physiological periferical changes for a later development of PLP and at the same time a lesser pain score has a better prognosis for PLP, considering the condition of the patient we chose an aggresive approach from the beggining to assure minimun risk with the least systemic repercussion, with this case we show an alternative to the often neuroaxial techniques when they are not a safe option.
Femoral Nerve Block
Placed Perineural Catheter