6 Prevention of chronic pain syndromes by anaesthetic measures: fact or fiction?

A clinically relevant benefit resulting from prophylactic analgesia has so far been observed in only a very few studies. In general, these effects have been limited to the immediate post-operative period. The most promising results have been observed with spinal opioids. However, several investigations on the effect of preventive analgesic measures have been performed in patients with lower limb amputation. In these studies, pre- and post-operative epidural analgesia with local anaesthetics and opioids, beginning at least 2 days preoperatively and continued for at least 3 days post-operatively, reduced the incidence of phantom limb pain by 50–90%. If epidural catheter placement is not possible, for example owing to systemic infection or trauma, 3 days continuous peripheral nerve block with 6–10 ml per hour bupivacaine 0.5% at the sciatic or posterior tibial nerve may be an alternative, provided that effective nerve block is established prior to amputation.