Cho Hyun-Seok, Kim Sooyoung, Kim Chan Sik, Kim Ye-Jee, Lee Jong-Hyuk, Leem Jeong-Gill
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea.
Korean J Pain. 2020 Jul 1;33(3):267-274. doi: 10.3344/kjp.2020.33.3.267.
General anesthesia (GA) has been considered the anesthetic technique which most frequent leads to phantom limb pain (PLP) after a limb amputation. However, these prior reports were limited by small sample sizes. The aims of this study were to evaluate the incidence of PLP according to the various anesthetic techniques used for limb amputation and also to compare the occurrence of PLP according to amputation etiology using the Korean Health Insurance Review and Assessment Service for large-scale demographic information.
The claims of patients who underwent limb amputation were reviewed by analyzing the codes used to classify standardized medical behaviors. The patients were categorized into three groups-GA, neuraxial anesthesia (NA), and peripheral nerve block (PNB)-in accordance with the anesthetic technique. The recorded diagnosis was confirmed using the diagnostic codes for PLP registered within one year after the limb amputation.
Finally, 7,613 individuals were analyzed. According to the recorded diagnoses, 362 patients (4.8%) developed PLP after amputation. Among the 2,992 patients exposed to GA, 191 (6.4%) were diagnosed with PLP, whereas 121 (4.3%) of the 2,840 patients anesthetized with NA, and 50 (2.8%) of the 1,781 patients anesthetized under PNB developed PLP. The relative risks were 0.67 (95% confidence interval [CI], 0.53-0.84; < 0.001) for NA and 0.43 (95% CI, 0.32-0.59; < 0.001) for PNB.
In this retrospective cohort study, using large-scale population-based databases, the incidence rates of PLP after limb amputations were, in the order of frequency, GA, NA, and PNB.
全身麻醉（GA）被认为是肢体截肢后最常导致幻肢痛（PLP）的麻醉技术。然而，这些先前的报告受样本量小的限制。本研究的目的是根据用于肢体截肢的各种麻醉技术评估PLP的发生率，并利用韩国健康保险审查和评估服务的大规模人口信息，比较根据截肢病因的PLP发生率。
通过分析用于分类标准化医疗行为的代码，对接受肢体截肢的患者的索赔进行审查。根据麻醉技术，将患者分为三组——全身麻醉、神经轴索麻醉（NA）和周围神经阻滞（PNB）。使用肢体截肢后一年内登记的PLP诊断代码确认记录的诊断。
最终，对7613名个体进行了分析。根据记录的诊断，362名患者（4.8%）截肢后出现PLP。在2992名接受全身麻醉的患者中，191名（6.4%）被诊断为PLP，而在2840名接受神经轴索麻醉的患者中，121名（4.3%）出现PLP，在1781名接受周围神经阻滞麻醉的患者中，50名（2.8%）出现PLP。神经轴索麻醉的相对风险为0.67（95%置信区间[CI]，0.53 - 0.84；<0.001），周围神经阻滞的相对风险为0.43（95%CI，0.32 - 0.59；<0.001）。
在这项使用大规模基于人群数据库的回顾性队列研究中，肢体截肢后PLP的发生率按频率排序为全身麻醉、神经轴索麻醉和周围神经阻滞。
