PLP Case Studies

In treating PLP, its onset can potentially be prevented by use of pre-emptive anesthesia prior to surgical amputation of the limb. This can prove to be valuable due to the fact that PLP develops rapidly post-amputation, and in one study it was found to be present in 84% of the subject group eight days post-amputation, and in 67% in the same group six months post-amputation (McCormick, Chang-Chien, Marshall, Huang, & Harden, 2014). Karanikolas et al. (2011) performed a prospective, randomized, double-blind clinical trial to investigate the use of perioperative analgesia to reduce PLP post-amputation. In Karanikolas et al. study, 65 patients underwent lower limb amputation and were divided into five groups; the first group received perioperative
PLP intensity was measured at 10 days, one month, and six months post-surgery. Karanikolas et al. (2011) concluded in their results that “rigorous perioperative analgesia reduces PLP prevalence, intensity, and frequency after elective lower-limb amputation” (p. 1150). Of all patients that received perioperative anesthesia, only 29.4% demonstrated a median intensity of PLP at the 6-month follow-up post surgery, with the Epi/Epi/Epi group showing the lowest scores on the MPQ during all follow-ups. A reduction in PLP was also demonstrated by comparing the Epi/Epi/Epi group vs. the control group in that the Epi/Epi/Epi group showed a marked decrease in the median pain score (20 on a scale of 1-100) at the 6-month follow-up while the control group was almost three times higher with a median score of
(2010) study, 62 subjects were given a continuous infusion of 0.5% ropivacaine during and post surgery amputation of a lower limb for a median duration of 30 days, and were removed from the anesthetic 6-12 hours prior to answering an in-depth questionnaire to evaluate their PLP using the standard verbal rating scale (VRS) with a score of 0=no pain, and the highest 4=intolerable pain, at weekly and monthly intervals for up to a year post surgery. Results showed that after the first week of treatment, phantom pain was reported by a majority of the patients with VRS scores ranging from 2 to 4, but by the fifth week of treatment, less than 10% of the patients reported mild pain at most, and no severe or intolerable pain. At the final evaluation at 12 months post surgery, 84% of the patients reported no PLP, and none reported intolerable