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J Clin Anesth. 2007 May;19(3):226-9.

The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain.

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Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.


We report the efficacy of perioperative infusion of clonidine and bupivacaine for above-knee amputation in a patient with a history of phantom limb pain in the same extremity after a previous below-knee amputation. The patient underwent general anesthesia. Before transection, the sciatic nerve was infiltrated with 0.25% bupivacaine 5 mL and clonidine 50 microg. After the nerve was severed, a 20-gauge epidural catheter was inserted into the nerve sheath and externalized laterally through a separate skin incision. Before closure, 0.25% bupivacaine 10 mL and clonidine 50 microg was injected, and 0.1% bupivacaine and clonidine two microg/mL was infused at 10 mL/h for the first 96 hours postoperatively. There were no incidents of hypotension, bradycardia, or sedation during the infusion period. The mean postoperative pain score (from 0 to 10) for 96 hours was 1.2 +/- 0.7. The patient required a total of 10 mg of oxycodone postoperatively. The patient did not report either stump or phantom pain for 12 months after surgery.

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