Theoretical rationale and technology of practical realization to prevent phantom-limb pain following elective limb amputation


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Abstract

High frequency of postamputational phantom pain syndrome (PPS) and poor efficiency of measures of its prophylaxis and managements determined the main goal of the study: to develop technology for prevention PPS during elective amputation of upper or lower extremity. The study resulted in purposeful choice of measures complex for special drug prophylaxis (SDP). Theoretically each of these measures is able to block specific peripheral or central mechanism of PPS. The SDP includes anticonvulsant (pregebalin or gabapentin), glucocorticosteroid (dexamethasone), protease inhibitor (aprotinin), NMDA-receptors antagonist (ketamine) and thricyclic antidepressant (amitriptyline). Pilot prospective controlled clinical study was conducted in order to investigate the SDP efficiency (n=28), added according to defined scheme to systemic (n=14) or combined (systemic and epidural, n=14)) anesthesia/analgesia following by postoperative prophylactic therapy. Complex assessment of the results including questionnaire of neuropathic pain diagnostics “Pain Detect” revealed that SDP symptoms were absent in all examined patients undergone amputation regardless of methods of intra- or postoperative anesthesia and analgesia. The novelty of developed technology is confirmed by patent on invention. Total number of patients undergone the amputation of lower (n=26) or upper (n=21) extremity equaled to 47 individuals. No PPS was recorded in each patient. The period of observation was from 6 months to 4 years.

About the authors

N. A. Osipova

Moscow Cancer Institute named after P. A. Hertzen

Moscow

V. V. Teplyakova

Moscow Cancer Institute named after P. A. Hertzen

Moscow

L. A. Sobchenko

Moscow Cancer Institute named after P. A. Hertzen

Moscow

V. V. Petrova

Moscow Cancer Institute named after P. A. Hertzen

Moscow

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