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A1381
October 15, 2007 2:00 PM - 4:00 PM Room Hall D, Area N, |
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| Management of Phantom Limb Pain According to WHO Analgesic Ladder in Amputees of Malignant Origin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Seema Mishra, M.D., Sushma Bhatnagar, M.D., Deepak Gupta, M.D., Alok Diwedi, Ph.D. Department of Anaesthesia, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India |
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The exact incidence of phantom pain is unclear, with values ranging from almost 0-100%. Antidepressants and anticonvulsants are currently considered to be the drug treatment of choice for neuropathic pain. Opioids are effective in relieving neuropathic pain including phantom pain in early postoperative course. The aims of the present study were (a) to know the incidence of phantom limb pain and phantom sensation and (b) to test the utility of WHO analgesic ladder in phantom limb pain management in amputees of malignant origin. Methods: This is a prospective study of 42 cancer patients who underwent upper or lower limb amputation. Patients were followed up in outpatient pain clinic every month for initial 2 months postoperatively and every 2 months thereafter for 2 years. The WHO analgesic ladder was followed for pain management. Results: The patients complaining of phantom sensation, phantom pain and stump pain decreased from 69%, 60% and 31% respectively at 1 month to 32%, 32% and 5% respectively at 2 years. Incidence of phantom pain decreased with addition of opioids (WHO Step II & III) in 20 out of 42 patients; eleven patients were effectively managed with tramadol, six patients with morphine and only three patients required change from tramadol to morphine. The frequently reported side effects were constipation (85%) and nausea/vomiting (25%). None of the patient had sedation or respiratory depression. Conclusion: Incidence of phantom sensation, phantom pain and stump pain decreased significantly over time The WHO analgesic ladder played significant role in phantom limb pain management.[table1][table2][figure1][figure2] Anesthesiology 2007; 107: A1381 |
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