Perioperative Pain Management for Major Limb Amputation – A Systematic-Narrative Hybrid Review

Gupta N, Leung C. The effect of post-amputation pain on health-related quality of life in lower limb amputees. Disabil Rehabil. 2022;44:2325–31. https://doi.org/10.1080/09638288.2020.1832589.

Article  CAS  PubMed  Google Scholar 

Bernatchez J, Mayo A, Kayssi A. The epidemiology of lower extremity amputations, strategies for amputation prevention, and the importance of patient-centered care. Semin Vasc Surg. 2021;34:54–8. https://doi.org/10.1053/J.SEMVASCSURG.2021.02.011.

Article  PubMed  Google Scholar 

Schwingler PM, Moman RN, Hunt C, Ashmore Z, Ogletree SP, Uvodich ME, et al. Prevalence of postamputation pain and its subtypes: a meta-analysis with meta-regression. Pain Rep. 2021;6: e918. https://doi.org/10.1097/PR9.0000000000000918.

Article  PubMed  PubMed Central  Google Scholar 

List EB, Krijgh DD, Martin E, Coert JH. Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis. Pain. 2021;162:1906–13. https://doi.org/10.1097/J.PAIN.0000000000002202.

Article  CAS  PubMed  Google Scholar 

Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One. 2020;15:e0240431. https://doi.org/10.1371/JOURNAL.PONE.0240431.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Hwang CD, Hoftiezer YAJ, Raasveld FV, Gomez-Eslava B, van der Heijden EPA, Jayakar S, et al. Biology and pathophysiology of symptomatic neuromas. Pain. 2023. https://doi.org/10.1097/J.PAIN.0000000000003055.

Article  PubMed  Google Scholar 

Eberlin KR, Ducic I. Surgical algorithm for neuroma management: A changing treatment paradigm. Plast Reconstr Surg Glob Open. 2018;6:1–8. https://doi.org/10.1097/GOX.0000000000001952.

Article  Google Scholar 

Eberlin KR, Brown DA, Gaston RG, Kleiber GM, Ko JH, Kovach SJ, et al. A consensus approach for targeted muscle reinnervation in amputees. Plast Reconstr Surg Glob Open. 2023;11:E4928. https://doi.org/10.1097/GOX.0000000000004928.

Article  PubMed  PubMed Central  Google Scholar 

Caragher SP, Khouri KS, Raasveld FV, Winograd JM, Valerio IL, Gfrerer L, et al. The peripheral nerve surgeon’s role in the management of neuropathic pain. Plast Reconstr Surg Glob Open. 2023;11:E5005. https://doi.org/10.1097/GOX.0000000000005005.

Article  PubMed  PubMed Central  Google Scholar 

Dumanian GA, Potter BK, Mioton LM, Ko JH, Cheesborough JE, Souza JM, et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial. Ann Surg. 2019;270:238–46. https://doi.org/10.1097/SLA.0000000000003088.

Article  PubMed  Google Scholar 

Raasveld F, Hoftiezer YAJ, Gomez-Eslava B, McCarty J, Valerio IL, Heng M, et al. Early post-operative pain course following primary and secondary targeted muscle reinnervation - a temporal description of pain outcomes. J Reconstr Microsurg. 2024. https://doi.org/10.1055/A-2404-7732.

Article  PubMed  Google Scholar 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA, et al. statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021:372. https://doi.org/10.1136/BMJ.N71.

Article  Google Scholar 

McQueen K, Coonan T, Ottaway A, et al. Anesthesia and perioperative care. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, et al. editors. Essential surgery: disease control priorities. Washington (DC): The World Bank; 2015. https://www.ncbi.nlm.nih.gov/books/NBK333510/

Dydyk AM, Conermann T. Chronic pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. https://pubmed.ncbi.nlm.nih.gov/31971706/

Bach S, Noreng MF, Tjéllden NU. Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain. 1988;33:297–301. https://doi.org/10.1016/0304-3959(88)90288-6.

Article  PubMed  Google Scholar 

Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine - PubMed n.d. https://pubmed.ncbi.nlm.nih.gov/7979074/ (accessed August 3, 2024).

Benedetti MG, De Santis L, Mariani G, Donati D, Bardelli R, Perrone M, et al. Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia? NeuroRehabilitation. 2021;49:129–38. https://doi.org/10.3233/NRE-210077.

Article  PubMed  Google Scholar 

Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S, et al. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011;114:1144–54. https://doi.org/10.1097/ALN.0B013E31820FC7D2.

Article  CAS  PubMed  Google Scholar 

Nikolajsen L, Ilkjaer S, Christensen JH, Krøner K, Jensen TS. Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet. 1997;350:1353–7. https://doi.org/10.1016/S0140-6736(97)06315-0.

Article  CAS  PubMed  Google Scholar 

Nikolajsen L, Ilkjær S, Jensen TS. Effect of preoperative extradural bupivacaine and morphine on stump sensation in lower limb amputees. Br J Anaesth. 1998;81:348–54. https://doi.org/10.1093/BJA/81.3.348.

Article  CAS  PubMed  Google Scholar 

Wilson JA, Nimmo AF, Fleetwood-Walker SM, Colvin LA. A randomised double blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation. Pain. 2008;135:108–18. https://doi.org/10.1016/J.PAIN.2007.05.011.

Article  CAS  PubMed  Google Scholar 

Niskakangas M, Dahlbacka S, Liisanantti J, Vakkala M, Kaakinen T. Spinal or general anaesthesia for lower-limb amputation in peripheral artery disease - a retrospective cohort study. Acta Anaesthesiol Scand. 2018;62:226–33. https://doi.org/10.1111/AAS.13019.

Article  CAS  PubMed  Google Scholar 

Sahin SH, Colak A, Arar C, Tutunculer E, Sut N, Yilmaz B, et al. A retrospective trial comparing the effects of different anesthetic techniques on phantom pain after lower limb amputation. Curr Ther Res Clin Exp. 2011;72:127–37. https://doi.org/10.1016/J.CURTHERES.2011.06.001.

Article  PubMed  PubMed Central  Google Scholar 

Aladin H, Jennings A, Hodges M, Tameem A. Major lower limb amputation audit - introduction and implementation of a multimodal perioperative pain management guideline. Br J Pain. 2018;12:230–7. https://doi.org/10.1177/2049463718769339.

Article  PubMed  PubMed Central  Google Scholar 

Borghi B, D’Addabbo M, White PF, Gallerani P, Toccaceli L, Raffaeli W, et al. The use of prolonged peripheral neural blockade after lower extremity amputation: the effect on symptoms associated with phantom limb syndrome. Anesth Analg. 2010;111:1308–15. https://doi.org/10.1213/ANE.0B013E3181F4E848.

Article  PubMed  Google Scholar 

Dumitrascu CI, Warner NS, Stewart TM, Amundson AW, Bruns DL, Hanson AC, et al. Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower-Extremity Amputation. Pain Pract. 2021;21:299–307. https://doi.org/10.1111/PAPR.12959.

Article  PubMed  Google Scholar 

Fatima H, Chaudhary O, Krumm S, Mufarrih SH, Mahmood F, Pannu A, et al. Enhanced Post-Operative Recovery with Continuous Peripheral Nerve Block After Lower Extremity Amputation. Ann Vasc Surg. 2021;76:399–405. https://doi.org/10.1016/J.AVSG.2021.03.029.

Article  PubMed  Google Scholar 

von Plato H, Peltoniemi M, Kauhanen P, Löyttyniemi E, Hamunen K, Kontinen V. Combination of perineural and wound infusion after above knee amputation: A randomized, controlled multicenter study. Acta Anaesthesiol Scand. 2019;63:1406–12. https://doi.org/10.1111/AAS.13440.

Article  Google Scholar 

Arjun BK, Prijith RS, Sreeraghu GM, Narendrababu MC. Ultrasound-guided popliteal sciatic and adductor canal block for below-knee surgeries in high-risk patients. Indian J Anaesth. 2019;63:635–9. https://doi.org/10.4103/IJA.IJA_296_19.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Kim NY, Lee KY, Bai SJ, Hong JH, Lee J, Park JM, et al. Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation: A retrospective observational study. Medicine. 2016;95:e4302. https://doi.org/10.1097/MD.0000000000004302.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Makkar JK, Bandyopadhay A, Jain K, Jafra A, Gopinathan NR, Singh P. Effect of perioperative sciatic nerve block on chronic pain in patients undergoing below-knee amputation: A randomised controlled trial. Indian J Anaesth. 2022;66:S300–6. https://doi.org/10.4103/IJA.IJA_796_21.

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