术后疼痛性幻肢综合征的管理：叙述性综述及临床处理建议。
Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.
作者信息
Valero Edmundo Gónima, Acosta Acosta Claudia Del Pilar, Vargas Useche Wilson, Orozco Sandoval Laura, Seija-Butnaru Daniela, Sánchez-Flórez Juan C, Linares Escobar Ricardo, Amaya Sebastian
机构信息
Pain Management and Palliative Care Medicine Specialist, Chief of the Pain and Palliative Care Department, Hospital Militar Central, Bogotá, Colombia.
Universidad del Rosario - Fundación Cardio Infantil, Hospital Militar Central, Bogotá, Colombia.
出版信息
J Pain Palliat Care Pharmacother. 2023 Jun;37(2):194-208. doi: 10.1080/15360288.2023.2187005. Epub 2023 Mar 17.
OBJECTIVE
Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation.
METHODS
A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process.
RESULTS
A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary.
CONCLUSION
The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.
目的
在接受截肢手术的患者中，50%至 80%会发生幻肢痛综合征（PPLS），这对生活质量、生产力和社会心理领域有重大影响。本综述的目的是总结药物和非药物策略、手术优化，并提供多学科方法，旨在降低接受肢体截肢的患者与 PPLS 相关的慢性疼痛发生率。
方法
使用 Medline、Pubmed、Proquest、LILACS 和 Cochrane 进行叙述性综述，检索 2000 年至 2021 年的文章。经过筛选过程，选择描述流行病学、病理生理考虑和当前治疗方法的文章。
结果
PPLS 需要多学科和多模式方法，包括使用区域技术和辅助药物，如 NSAIDs、氯胺酮、利多卡因和加巴喷丁类药物。此外，有必要与手术团队一起评估和持续管理慢性疼痛的风险因素。
结论
目前的文献并不支持单一技术对 PPLS 的预防有效。然而，在多学科和多模式方法下，充分控制急性疼痛、康复和早期恢复身体模式在急性环境中显示出益处。
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