Review Article

Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

Table 2

Complexity of pain associated with lower limb amputation.

Onset & durationCommentsReferences

Ischemic limb painPreoperative to intraoperative.Pain intensity prior to amputation is a significant predictor of developing chronic limb pain.[11, 12]

Residual limb pain (stump pain)Intraoperative to 1-2 weeks postoperative. Median pain 15.5 on a 0–100 visual analog scale in the first week postoperatively. Severe pain in 5–10% of patients.Stump pain (sharp, localized pain) gradually lessens as the wound heals. May be prolonged if complications arise such as infection, tissue necrosis, wound dehiscence, osteomyelitis, and neuroma formation.[10, 11, 13, 14]

Phantom limb painOnset 1–7 days postoperative (or longer). Incidence up to 85%. Mean pain 22 on a 0–100 visual analog scale at 6 months after amputation. Severe pain in 5–10% of patients. May persist for months to years.Symptoms: Intermittent (or sometimes constant) aching, cramping, burning, shooting, stabbing, boring, squeezing, or throbbing pains. Multiple poorly understood etiologies.[10, 11, 13, 15, 16]

Phantom limb sensationsOnset 1–7 days postoperative. Incidence up to 90%. May persist for months to years.Symptoms: Nonpainful sensations that the amputated limb still exists but may feel twisted deformed or have muscle cramps, tingling or itching. Multiple poorly understood etiologies.[10, 11, 13, 15]

Other musculoskeletal painPostoperative.Back, hip, and knee pain with gait abnormalities related to changes in mechanics due to the amputated limb/prosthetic.[10, 17]