[Anesthesia and analgesia for lower limb amputation]

This study describes the methods of anesthesia and analgesia used in 296 limb amputations for vascular disease over a fifteen year period (1986-2000). The main type of anesthesia was general in 55%, epidural in 29% and spinal in 14%: there were no significant differences for ASA grade, age, or amputation level, nor any statistical differences in mortality for each method of anesthesia. The main methods of analgesia in the first 48 hours changed between 1986 and 1998, with decreasing intramuscular and oral opioids (from 42% to 1%, and from 14% to 1% respectively) while epidurals became the commonest method (2% in 1986 and 83% in 2000). Thirty-seven percent of patients were prescribed pethidine for phantom pain. There have been substantial changes in postoperative analgesia following amputation, and epidurals are now common practice, despite the controversy about their role in preventing phantom pain.