Long-Term Intrathecal Infusion of Opioid and/or Bupivacaine in the Prophylaxis and Treatment of Phantom Limb Pain

ABSTRACT Introduction and Methods. A prospective, open case study was performed on 37 patients, given intrathecal (IT) bupivacaine alone or bupivacaine/opioid combinations for refractory pain located in the extremities to explore the potential of this therapy for prophylaxis against post‐amputation pain (PLP) and/or the treatment of severe, established PLP. Intrathecal infusions were administered before, during, and after amputation, as an attempt to prevent PLP (“prophylaxis group”; n = 21), or to relieve existing severe PLP after previous amputations (“treatment group”; n = 16). Results. All patients but one in the prophylaxis group obtained 60–100% pain relief during intrathecal therapy. Systemic daily doses of opioid decreased approximately threefold from pre‐intrathecal therapy, analgesic/sedative consumption was reduced by 50% and nocturnal sleep duration improved from 2–4 h to 6–8 h post intrathecal therapy. During post‐amputation IT treatment, transient PLP of less than 1 day duration and/or phantom limb sensation (PLS) occurred in 9 patients in the “prophylaxis group” and in 2 patients in the “treatment group.” 4 out of 16 patients (25%) in the prophylactic group and 0 out of 10 (0%) in the treatment group presented neither PLP nor PLS after termination of the IT treatment. Conclusions. Continuous IT infusion of bupivacaine with or without opioid gave satisfactory pain relief during the treatment in 95% of the patients. Continuous IT infusion of bupivacaine, alone or in combination with opioid, relieved severe preexisting PLP during the treatment in 100% of the treated patients, but did not prevent its recurrence after the end of the intrathecal treatment.