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Effects of different anesthetic techniques on the incidence of phantom limb pain after limb amputation: a population-based retrospective cohort study

  • Cho, Hyun-Seok (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sooyoung (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Chan Sik (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ye-Jee (Department Clinical Epidemiology and Biostatistics, Asan Medical Center) ;
  • Lee, Jong-Hyuk (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Leem, Jeong-Gill (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.03.13
  • Accepted : 2020.05.22
  • Published : 2020.07.01

Abstract

Background: General anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information. Methods: The claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups-GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)-in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation. Results: Finally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53-0.84; P < 0.001) for NA and 0.43 (95% CI, 0.32-0.59; P < 0.001) for PNB. Conclusions: In this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.

Keywords

References

  1. Hsu E, Cohen SP. Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res 2013; 6: 121-36. https://doi.org/10.2147/JPR.S32299
  2. Kawashima N, Mita T, Yoshikawa M. Inter-individual difference in the effect of mirror ref lection-induced visual feedback on phantom limb awareness in forearm amputees. PLoS One 2013; 8: e69324. https://doi.org/10.1371/journal.pone.0069324
  3. Nardone R, Langthaler PB, Holler Y, Bathke A, Frey VN, Brigo F, et al. Modulation of non-painful phantom sensation in subjects with spinal cord injury by means of rTMS. Brain Res Bull 2015; 118: 82-6. https://doi.org/10.1016/j.brainresbull.2015.09.006
  4. Wilkins KL, McGrath PJ, Finley GA, Katz J. Prospective diary study of nonpainful and painful phantom sensations in a preselected sample of child and adolescent amputees reporting phantom limbs. Clin J Pain 2004; 20: 293-301. https://doi.org/10.1097/00002508-200409000-00003
  5. Sherman RA, Sherman CJ. Prevalence and characteristics of chronic phantom limb pain among American veterans. Results of a trial survey. Am J Phys Med 1983; 62: 227-38.
  6. Sherman RA, Sherman CJ, Parker L. Chronic phantom and stump pain among American veterans: results of a survey. Pain 1984; 18: 83-95. https://doi.org/10.1016/0304-3959(84)90128-3
  7. Davis RW. Phantom sensation, phantom pain, and stump pain. Arch Phys Med Rehabil 1993; 74: 79-91.
  8. Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage 2002; 24: 578-85. https://doi.org/10.1016/S0885-3924(02)00538-9
  9. Montoya P, Larbig W, Grulke N, Flor H, Taub E, Birbaumer N. The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees. Pain 1997; 72: 87-93. https://doi.org/10.1016/S0304-3959(97)00004-3
  10. Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A, van der Schans CP. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000; 87: 33-41. https://doi.org/10.1016/S0304-3959(00)00264-5
  11. Hanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain 2007; 8: 102-9. https://doi.org/10.1016/j.jpain.2006.06.004
  12. 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
  13. Yarnitsky D, Barron SA, Bental E. Disappearance of phantom pain after focal brain infarction. Pain 1988; 32: 285-7. https://doi.org/10.1016/0304-3959(88)90040-1
  14. Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci 2006; 7: 873-81. https://doi.org/10.1038/nrn1991
  15. Ong BY, Arneja A, Ong EW. Effects of anesthesia on pain after lower-limb amputation. J Clin Anesth 2006; 18: 600-4. https://doi.org/10.1016/j.jclinane.2006.03.021
  16. 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
  17. Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9: 85-91. https://doi.org/10.1111/j.1538-7836.2010.04108.x
  18. Hall GC, Morant SV, Carroll D, Gabriel ZL, McQuay HJ. An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population. BMC Fam Pract 2013; 14: 28. https://doi.org/10.1186/1471-2296-14-28
  19. Pisansky AJB, Brovman EY, Kuo C, Kaye AD, Urman RD. Perioperative outcomes after regional versus general anesthesia for above the knee amputations. Ann Vasc Surg 2018; 48: 53-66. https://doi.org/10.1016/j.avsg.2017.10.014
  20. Raichle KA, Osborne TL, Jensen MP, Ehde DM, Smith DG, Robinson LR. Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation. Clin J Pain 2015; 31: 699-706. https://doi.org/10.1097/AJP.0000000000000150
  21. Wolff A, Vanduynhoven E, van Kleef M, Huygen F, Pope JE, Mekhail N. 21. Phantom pain. Pain Pract 2011; 11: 403-13. https://doi.org/10.1111/j.1533-2500.2011.00454.x
  22. Schley MT, Wilms P, Toepfner S, Schaller HP, Schmelz M, Konrad CJ, et al. Painful and nonpainful phantom and stump sensations in acute traumatic amputees. J Trauma 2008; 65: 858-64. https://doi.org/10.1097/TA.0b013e31812eed9e
  23. Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE. Raj's practical management of pain. 4th ed. Philadelphia, Mosby-Elsevier. 2008.
  24. Bloomquist T. Amputation and phantom limb pain: a painprevention model. AANA J 2001; 69: 211-7.
  25. Clark RL, Bowling FL, Jepson F, Rajbhandari S. Phantom limb pain after amputation in diabetic patients does not differ from that after amputation in nondiabetic patients. Pain 2013; 154: 729-32. https://doi.org/10.1016/j.pain.2013.01.009
  26. Buchheit T, Van de Ven T, Hsia HL, McDuffie M, MacLeod DB, White W, et al. Pain phenotypes and associated clinical risk factors following traumatic amputation: results from Veterans Integrated Pain Evaluation Research (VIPER). Pain Med 2016; 17: 149-61.
  27. Esfandiari E, Yavari A, Karimi A, Masoumi M, Soroush M, Saeedi H. Long-term symptoms and function after war-related lower limb amputation: a national cross-sectional study. Acta Orthop Traumatol Turc 2018; 52: 348-51. https://doi.org/10.1016/j.aott.2017.04.004
  28. Ahmad J, Gupta AK, Sharma VP, Kumar D, Yadav G, Singh S. Traumatic amputations in children and adolescents: a demographic study from a tertiary care center in Northern India. J Pediatr Rehabil Med 2016; 9: 265-9. https://doi.org/10.3233/PRM-160398
  29. Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain 2009; 13: 719-30. https://doi.org/10.1016/j.ejpain.2008.07.015
  30. Montoya P, Ritter K, Huse E, Larbig W, Braun C, Topfner S, et al. The cortical somatotopic map and phantom phenomena in subjects with congenital limb atrophy and traumatic amputees with phantom limb pain. Eur J Neurosci 1998; 10: 1095-102. https://doi.org/10.1046/j.1460-9568.1998.00122.x
  31. Probstner D, Thuler LC, Ishikawa NM, Alvarenga RM. Phantom limb phenomena in cancer amputees. Pain Pract 2010; 10: 249-56. https://doi.org/10.1111/j.1533-2500.2009.00340.x
  32. DeMoss P, Ramsey LH, Karlson CW. Phantom limb pain in pediatric oncology. Front Neurol 2018; 9: 219. https://doi.org/10.3389/fneur.2018.00219
  33. Smith J, Thompson JM. Phantom limb pain and chemotherapy in pediatric amputees. Mayo Clin Proc 1995; 70: 357-64. https://doi.org/10.4065/70.4.357
  34. Kim SY, Kim YY. Mirror therapy for phantom limb pain. Korean J Pain 2012; 25: 272-4. https://doi.org/10.3344/kjp.2012.25.4.272
  35. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983; 17: 243-56. https://doi.org/10.1016/0304-3959(83)90097-0
  36. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 1985; 21: 267-78. https://doi.org/10.1016/0304-3959(85)90090-9
  37. Nikolajsen L, Ilkjaer S, Kroner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997; 72: 393-405. https://doi.org/10.1016/S0304-3959(97)00061-4
  38. Bach S, Noreng MF, Tjellden 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