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A study was carried to assess if an ambulatory continuous peripheral nerve block of six days would offer efficacious and lasting analgesia for the established lower and upper-extremity post-amputation phantom pain.
A six-day continuous peripheral
nerve block was found to alleviate phantom limb pain, and pain-stimulated
emotional and physical dysfunction for about one month.
A study was carried to assess if an ambulatory continuous peripheral nerve block of six days would offer efficacious and lasting analgesia for the established lower and upper-extremity post-amputation phantom pain.
This randomized, parallel-arm,
multicenter, quadruple-masked, placebo-controlled clinical trial enrolled
participants who had a lower or upper-limb amputation and established phantom
pain. Each subject was randomly divided to receive a six-day perineural administration
of either normal saline or ropivacaine. The average pain severity as estimated
with a Numeric Rating Scale (NRS) at four weeks, after which an optional
crossover therapy was administered within 0 to 12 weeks was the major endpoint.
Both the arms displayed comparable pre-therapeutic pain scores, illustrating a median (interquartile range) of 5.0 (4.0, 7.0) for each arm. After four weeks, the average phantom pain intensity was a mean (standard deviation) of 3.0 (2.9) in individuals administered local anesthetic vs 4.5 (2.6) in individuals administered a placebo.
Subjects receiving local anesthetic illustrated improved global impression of
change and reduced pain-induced physical and emotional dysfunction but were not
found to differ on depression scores. In the case of individuals receiving only
the first infusion (without any self-selected crossover), the median decline in
pain at six months for the treated participants was 3.0 (0, 5.0) vs 1.5 (0,
5.0) for the placebo group. At 12 months, there appeared to be a little
residual advantage.
Ambulatory continuous peripheral
nerve block effectively minimizes postamputation limb pain and improves
emotional and physical dysfunction.
Pain
Ambulatory continuous peripheral nerve blocks to treat postamputation phantom limb pain: a multicenter, randomized, quadruple-masked, placebo-controlled clinical trial
Brian M Ilfeld et al.
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