Post-operative pain management in lower limb major amputation : the influence of timing analgesia

Abstract

Lower limb Amputation surgery is associated with pain which can occur both pre- and post operatively. The latter can be either acute immediate stump pain or chronic phantom limb pain. Preoperative pain increases the risk of chronic phantom limb pain. Around ninety lower limb major amputations are performed each year at Mater dei Hospital. The aim of this prospective observational study was to follow up patients who received opioids as analgesia before (Group 1) or after amputation surgery (Group 2) both in the acute and chronic period. The effect of these interventions on the mean length of stay compared to patients receiving opioids analgesia after the amputation alone was also assessed. Patients undergoing elective major lower limb amputation at Mater Dei teaching Hospital over a six month period (June 2011 to December 2011) were selected. Thirty patients were eligible for further analysis. Twelve patients were allocated to Group 1: 22.2% were on pethidine, 66.6% on morphine and 11.2 % received codeine. Group 2, which did not receive opioids pre-operative, consisted of eighteen patients .Post-operative pain was assessed using the Visual Analogue Scale on day 1, J and 7, month J and 6 post-operative. Doth stump pain and phantom limb pain was assessed. Analysis of variance statistical analysis was used to compare the results from two groups.