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[Practice of perioperative phantom limb pain prevention in Germany: a nationwide survey]
Jan D Wandrey1,2, Michael Schäfer3,4, Joachim Erlenwein4,5
1Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland. jan.wandrey@charite.de.
Background:
The prevalence of phantom limb pain after major amputation remains high and affected patients suffer from relevant impairments in the quality of life. Perioperative treatment strategies may prevent phantom limb pain. This study aims to assess the state of the perioperative anesthesiological pain management for major amputations. Furthermore, it analyzes potentials for optimization and barriers towards a better treatment of patients with amputations.
Material And Methods:
This online survey was distributed by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) mailing list of anesthesiological consultants. It was approved by the Charité ethics board.
Results:
Overall, 402 persons participated in this survey. Mostly, general anesthesia (85%), regional anesthesia (63%) and neuraxial anesthesia (49%) were performed in different combinations. Furthermore, 72% of participants reported using i.v. opioids postoperatively, mostly applied via patient-controlled analgesia (PCA). In contrast, preoperative regional anesthesia (74%) and gabapentinoids (67%) were seen as potential methods to improve treatment; however, barrier analysis revealed that treatment options are limited especially by organizational aspects and intrinsic patient factors.
Conclusion:
This survey describes the current practice of phantom limb pain prevention in Germany. It shows an unmet need for specialized perioperative pain treatment. As the evidence regarding treatment recommendations is limited, further research questions can be deduced from this study.
