Wandrey Jan D, Schäfer Michael, Erlenwein Joachim, Tafelski Sascha
Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland.
Anaesthesiologie. 2022 Nov;71(11):834-845. doi: 10.1007/s00101-022-01188-7. Epub 2022 Aug 29.
The prevalence of phantom limb pain after major amputation remains high and affected patients suffer from relevant impairments in the quality of life. Perioperative treatment strategies may prevent phantom limb pain. This study aims to assess the state of the perioperative anesthesiological pain management for major amputations. Furthermore, it analyzes potentials for optimization and barriers towards a better treatment of patients with amputations.
This online survey was distributed by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) mailing list of anesthesiological consultants. It was approved by the Charité ethics board.
Overall, 402 persons participated in this survey. Mostly, general anesthesia (85%), regional anesthesia (63%) and neuraxial anesthesia (49%) were performed in different combinations. Furthermore, 72% of participants reported using i.v. opioids postoperatively, mostly applied via patient-controlled analgesia (PCA). In contrast, preoperative regional anesthesia (74%) and gabapentinoids (67%) were seen as potential methods to improve treatment; however, barrier analysis revealed that treatment options are limited especially by organizational aspects and intrinsic patient factors.
This survey describes the current practice of phantom limb pain prevention in Germany. It shows an unmet need for specialized perioperative pain treatment. As the evidence regarding treatment recommendations is limited, further research questions can be deduced from this study.
大截肢术后幻肢痛的发生率仍然很高，受影响的患者生活质量受到相关损害。围手术期治疗策略可能预防幻肢痛。本研究旨在评估大截肢围手术期麻醉疼痛管理的现状。此外，它分析了优化的潜力以及截肢患者更好治疗的障碍。
这项在线调查通过德国麻醉与重症医学学会（DGAI）麻醉顾问邮件列表分发。它获得了夏里特伦理委员会的批准。
总体而言，402人参与了这项调查。大多数情况下，全身麻醉（85%）、区域麻醉（63%）和椎管内麻醉（49%）以不同组合进行。此外，72%的参与者报告术后使用静脉注射阿片类药物，大多通过患者自控镇痛（PCA）给药。相比之下，术前区域麻醉（74%）和加巴喷丁类药物（67%）被视为改善治疗的潜在方法；然而障碍分析显示，治疗选择尤其受到组织方面和患者自身因素的限制。
这项调查描述了德国目前预防幻肢痛的实践。它表明对专门的围手术期疼痛治疗存在未满足的需求。由于关于治疗建议的证据有限，可从本研究中推断出进一步的研究问题。
