Pain associated with Amputation

Pre-Operative Pain

Significant pain may be experienced in the preoperative period due to gangrene, vascular disease, a tumor, infection or trauma, and may continue right up to the moment of surgery.

This pain and anxiety relief may require narcotic and non-narcotic pain medications, anti-anxiety medications, and other techniques that should be familiar to the physician, surgeon, and anesthesiologist providing care. This is not a time to suffer in silence. This is a time to ask for, and, if necessary, demand adequate relief of pain and anxiety. When a person experiences pain, the chemicals produced by the brain to deal with pain and stress are used at a rapid rate. Once depleted, they are not available in the postoperative period to assist with recovery. Going to the operating room for an amputation in a calm, relatively pain-free state is much more conducive to an easy recovery than doing so after days or weeks of severe, unrelieved pain and anxiety. In addition, medical literature increasingly suggests that excellent pain relief (analgesia) in the preoperative period may result in a decrease of ongoing postoperative pain.

Intra-operative pain

Amputation is, unfortunately, a painful surgical procedure. Every type of tissue in the limb is severed during the amputation, including skin, muscle, bone, tendon, nerve, and blood vessels. Every one of these tissues has abundant nerve endings and all can hurt during and after amputation.

Preventing Pain

Anesthesia has been used for amputations since it was invented over 100 years ago. Usually, a type of general anesthetic that puts patients to sleep is used, rendering the patient unaware of the amputation and its painful nature. Recently, several studies have revealed that interrupting the painful nerve impulses before they reach the brain may actually decrease the probability of long-term post-amputational pain.

For many years, medical science has known that injecting Novocaine, Cocaine, Procaine, Marcaine, or Lidocaine in or around the nerves can prevent pain impulses from reaching the brain. The anesthesia can be injected into either the nerve or nerve sheath itself, the spinal cord (spinal analgesia), the area just outside the spinal cord (epidural analgesia) or a combination of these places. There is often confusion about the difference between spinal and epidural anesthesia. Spinal anesthesia involves injection of the medication in the space right next to the spinal cord (between the spinal cord and the dura – the cord’s covering). It is usually a one-time shot, and a catheter is rarely left in for repeat injections. An epidural involves injection of the medication in the epidural space (outside of the dura). With this technique, a catheter is usually left in place for repeat injections over longer periods. Occasionally, the epidural catheter is left in place for several days to give postoperative pain relief.

The anesthesiologist often employs a combination of techniques. The patient about to undergo an amputation should always discuss in detail with the anesthesiologist and surgeon the techniques and anesthetics they plan to use during surgery. This discussion should focus on issues of safety, risks, and pain relief during and after the surgery. There may be excellent reasons that one anesthetic technique is recommended over another. This is the time when an informed consumer is his or her own best advocate.

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