Korean J Pain.  2020 Jul;33(3):267-274. 10.3344/kjp.2020.33.3.267.

Effects of different anesthetic techniques on the incidence of phantom limb pain after limb amputation: a population-based retrospective cohort study

• Cho HS
• Kim S
• Kim CS
• Kim YJ
• Lee JH
• Leem JG

• KMID: 2504072
• DOI: http://doi.org/10.3344/kjp.2020.33.3.267

Abstract

Background
General anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information.
Methods
The claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups—GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)—in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation.
Results
Finally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53–0.84; P < 0.001) for NA and 0.43 (95% CI, 0.32–0.59; P < 0.001) for PNB.
Conclusions
In this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.

Keyword

Amputation; Amputees; Anesthesia; Chronic Pain; Incidence; Nerve Block; Neuralgia; Phantom Limb; Retrospective Studies

Figure

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  Fig. 1 Flow diagram of study enrollment. Of the 10,806 enrolled subjects, 7,613 patients were included and divided into three anesthetic groups.

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  Fig. 2 Kaplan–Meier curve estimates of the effects of different anesthesia approaches on the incidence of phantom limb pain (PLP) after amputation. Compared with the general anesthesia group, amputees who had undergone neuraxial anesthesia and peripheral nerve block during the surgery have lower probabilities of PLP (log-rank test, P < 0.001 for all comparisons).

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