Perioperative care for lower limb amputation in vascular disease

Melsom, H; Danjoux, Gerard

doi:10.1093/bjaceaccp/mkr024

Cited by 12 publications

(9 citation statements)

References 16 publications

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Section: The Underlying Complexity Of Pain In Lower Limb Amputatiomentioning

confidence: 99%

“…The majority of patients who require LLA typically have lengthy histories of ischemic limb pain and have been established on analgesic regimes that may include high doses of opioid [ 9 ]. Therefore, such patients will benefit from the involvement of an Acute Pain Service team to develop a multimodel analgesic regime and optimize their pain management before and immediately after a LLA [ 9 ]. Since pain intensity prior to amputation is a significant predictor of developing chronic limb pain, it must be emphasized that aggressive and early treatment of pain preoperatively and postoperatively may be important to attenuate chronic limb pain [ 11 , 12 , 19 ].…”

Section: The Underlying Complexity Of Pain In Lower Limb Amputatiomentioning

confidence: 99%

“…In the vasculopathic patient, significant coronary atherosclerosis is common. In fact, LLA may be associated with a 30-day mortality as high as 17% [ 9 ]. Prior to prescribing any medications to LLA patients, comorbidities such as cardiovascular disease, cardiac conduction disorders, renal dysfunction, liver disease, and depression must be taken into account since dosing and level of monitoring may need to be adjusted accordingly [ 24 ].…”

Section: Development Of a Multimodal Analgesia Protocol For Lower mentioning

confidence: 99%

“…It may be reasonable to add a low-dose NSAID in the short term or for treating breakthrough pain, as long as renal function is adequate and there are no contraindications. However, routine or long-term use of NSAIDs is not recommended because of the increased risk for gastrointestinal and renal toxicity in this patient population [ 9 ].…”

Section: Development Of a Multimodal Analgesia Protocol For Lower mentioning

confidence: 99%

“…Patients will benefit from multimodal combinations that hold favourable profiles when considering the specific requirements of both their particular surgical procedure and their medical comorbidities [ 2 , 3 , 8 ]. Lower limb amputation (LLA) in vasculopathic patients presents such a unique challenge, since anticoagulation issues are common in the perioperative period as well as the prevalence of significant cardiopulmonary disease [ 9 ]. Furthermore, practitioners must consider not only acute postoperative pain but also chronic ischemic pain, residual limb pain, phantom limb sensations, musculoskeletal pain, and the possible development of phantom limb pain [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

Jong

Shysh

2018

Pain Research and Management

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Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

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Section: The Underlying Complexity Of Pain In Lower Limb Amputatiomentioning

confidence: 99%

Section: The Underlying Complexity Of Pain In Lower Limb Amputatiomentioning

confidence: 99%

Section: Development Of a Multimodal Analgesia Protocol For Lower mentioning

confidence: 99%

Section: Development Of a Multimodal Analgesia Protocol For Lower mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

Jong

Shysh

2018

Pain Research and Management

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Amputation in Trauma—How to Achieve a Good Result from Lower Extremity Amputation Irrespective of the Level

et al. 2019

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Purpose of Review To provide an overview of patient management and surgical technique regarded as best practice in optimising outcome following primary and secondary amputation in trauma patients. This is supported by evidence where available. Recent Findings There is increasing evidence that primary amputation may offer superior outcome to reconstruction in severe open lower limb injuries, particularly segmental trauma involving the foot and tibia. Similarly, patients considering complex reconstructive procedures for failed trauma management should be counselled that reported outcomes are equivalent or better following amputation and are achieved faster and with less complications. Patients should be fully informed of this when making decisions about management, though this needs to be individualised. Various surgical techniques have been associated with improved outcome and these are described herein. Careful peri-operative pain management has been associated with faster rehabilitation, better psychological response and a reduced risk of chronic pain. On discharge, patients should be linked to rehabilitation, prosthetic and clinical psychology services and these should be integrated where possible. Summary A holistic, multidisciplinary approach is recommended in all aspects of care and should be available from the outset. Patients should be optimised medically and functionally, where possible pre-operatively. Psychological assessment and early information sharing are recommended. Where this is not possible due to acuity, these issues should be addressed as soon as possible post-amputation. Particularly where the limb is severely injured, careful planning and joint operating by senior Orthopaedic, Plastic and Vascular surgeons can achieve the best results.

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Postoperative and Preprosthetic Care

Gravano¹,

Lusardi²

2020

Orthotics and Prosthetics in Rehabilitation

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Perioperative care for lower limb amputation in vascular disease

Cited by 12 publications

References 16 publications

Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

Amputation in Trauma—How to Achieve a Good Result from Lower Extremity Amputation Irrespective of the Level

Postoperative and Preprosthetic Care

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