Amputation and the prevention of phantom pain

Although it has been proposed that preoperative analgesia with epidural adm inistration of analgesics may prevent long-term phantom pain, published res ults to date have been contradictory and controversial. In this case report , we describe a 41-year-old man with local recurrence of squamous cell carc inoma of the anus who underwent a hemipelvectomy. Preoperatively he had a s ignificant neuropathic pain syndrome requiring oxycodone 60,ng every 4 hour s. An epidural infusion of morphine and bupivacaine teas started 24 hours p reoperatively and discontinued on the third postoperative day. Over the nex t 10 days the oxycodone was gradually decreased and eventually discontinued prior to discharge. A review of the literature reveals conflicting reports on the benefit of preoperative epidural pain management in the prevention of postoperative pain syndromes. Conflicting research and conclusions of co mmentators leaves unanswered questions for clinicians. Nevertheless, we do know that we need to provide the best pain relief for patients both before and after amputation. This may require a combination of the oral, subcutane ous or intravenous, and epidural routes. (C) U.S. Cancer Pain Relief Commit tee, 2000.