Fenton-May L, Irvine M, Huckle D, Carter P
Department of Anaesthesia Cardiff & Vale University Health Board Cardiff UK.
Anaesth Rep. 2024 May 1;12(1):e12296. doi: 10.1002/anr3.12296. eCollection 2024 Jan-Jun.
Inadequately managed amputation pain can contribute to postoperative morbidity and mortality. However, amputation pain can be challenging to manage due to its complex nature, with both central and peripheral nociceptive and neuropathic elements. Here, we present the case of a 47-year old man who developed irreversible ischaemic injuries to all four limbs following admission to intensive care with sepsis. He required quadruple amputation and we describe our approach to his peri-operative management including anaesthesia, invasive monitoring and the multi-modal approach to his peri-operative management using a combination of intravenous analgesics, bilateral brachial plexus nerve catheters and a combined spinal and epidural. The patient made a good recovery and was able to return home from a rehabilitation facility 12 months after the operation, able to undertake many tasks himself with the aid of prosthetics.
截肢疼痛若管理不当，会导致术后发病和死亡。然而，由于截肢疼痛具有复杂的性质，涉及中枢和外周伤害性及神经性因素，因此其管理颇具挑战性。在此，我们介绍一例47岁男性病例，该患者因败血症入住重症监护病房后，四肢均出现不可逆缺血性损伤。他需要进行四肢截肢手术，我们描述了对其围手术期的管理方法，包括麻醉、有创监测以及采用静脉镇痛剂、双侧臂丛神经导管和腰麻-硬膜外联合麻醉相结合的多模式围手术期管理方法。患者恢复良好，术后12个月能够从康复机构回家，借助假肢能够自己完成许多任务。
