Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.

IF 0.9 Q3 ANESTHESIOLOGY

Journal of Pain & Palliative Care Pharmacotherapy Pub Date : 2023-06-01 DOI:10.1080/15360288.2023.2187005

Edmundo Gónima Valero, Claudia Del Pilar Acosta Acosta, Wilson Vargas Useche, Laura Orozco Sandoval, Daniela Seija-Butnaru, Juan C Sánchez-Flórez, Ricardo Linares Escobar, Sebastian Amaya

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Abstract

Objective: Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation.

Methods: A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process.

Results: A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary.

Conclusion: The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.

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疼痛幻肢综合征的围手术期治疗:综述及临床治疗建议。

目的:疼痛性幻肢综合征(pps)在截肢患者中发生率为50% ~ 80%，对患者的生活质量、生产能力和心理社会产生了很大的影响。本综述的目的是总结药理学和非药理学策略，手术优化，并提供一个多学科的方法，旨在减少截肢患者与pps相关的慢性疼痛的发生率。方法:使用Medline、Pubmed、Proquest、LILACS和Cochrane进行叙述性综述，检索2000 - 2021年的文献。文章描述流行病学，病理生理学的考虑，并在筛选过程后选择当前的治疗。结果:pps需要多学科和多模式的方法，应该包括使用区域技术和辅助剂，如非甾体抗炎药、氯胺酮、利多卡因和加巴喷丁类药物。此外，与外科团队一起评估和持续管理慢性疼痛的危险因素是必要的。结论:目前的文献并不支持单一的技术可以有效地预防pps。然而，在多学科和多模式的方法下，适当的急性疼痛控制、康复和早期身体恢复方案在急性环境中显示出益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pain & Palliative Care Pharmacotherapy ANESTHESIOLOGY-

CiteScore

1.60

自引率

9.10%

发文量