Epidural Oxycodone for Prevention of Phantom limb Pain in Patients Undergoing Major Lower Limb Amputation: A Randomized Controlled Trial

Document Type : Letter to the editor

Authors

1 Department of anesthesia and surgical ICU and pain management, Faculty of medicine, Kafrelsheikh university, Kafrelsheikh, Egypt

2 Anesthesia and surgical ICU and Pain management, Faculty of medicine, Kafrelsheikh university, Kafrelsheikh, Egypt

Abstract

Background
Postoperative care for patients undergoing major lower limb amputations carries special challenges for both the anaesthetist and pain therapist. In our study we assessed the efficacy of epidural oxycodone in postoperative pain control and prevention of phantom limb pain in patients undergoing major lower limb amputation under general anesthesia.
Settings and Design
Prospective randomized controlled trial.
Methods
This work enrolled 40 patients undergoing lower limb amputation under general anaesthesia with epidural analgesia. Patients were randomized into two groups. Group O received a bolus dose of 0.15mg/kg plus 20ml bupivacaine 0.25% followed by an infusion 0.03mg/kg/h oxycodone plus 0.1ml/Kg/h bupivacaine 0.125% and group C were given a bolus 20ml bupivacaine 0.25% followed by an infusion 0.1ml/Kg/h bupivacaine 0.125%. Vital signs were recorded. Visual analogue scale was recorded postoperatively at 2, 4, 6, 12, 18, 24, 36 and 48 hours. Postoperative total dose of rescue analgesic morphine and timing of first analgesic request were recorded. Incidence of phantom limb pain up to 3 months after surgery was assessed. Postoperative opioid related adverse reactions were recorded in both groups.
Results
Mean heart rate in patients of group O was significantly lower at 6- and 12-hours intervals postoperatively than in patients of group C (P2= 0.002 and 0.003). Mean arterial blood pressure in patients of group O was significantly lower at 6- and 12-hours intervals postoperatively than in patients of group C (P2= 0.027 and 0.001 respectively). Group O showed significantly lower VAS scores at 6, 12 and 18 hours post-operatively in comparison with patients group C (p= 0.002, 0.021 and 0.002 respectively). Patients of group O showed less total morphine consumption and later request for rescue analgesia than patients of Group C in a statistically significant way (p= 0.001 and 0.001). Phantom limb pain at 3 months post-operatively was found to be statistically less in patients of group O (p= 0.021). Patients of group O showed statistically significant less incidence of PONV and pruritis in comparison to the patients of group C (p= 0.046 and 0.022 respectively).
Conclusions
Epidural oxycodone infusion may be beneficial in both control of acute postoperative pain and prevention of phantom limb pain in patients undergoing major lower limb amputations.

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