Anaesthesia and analgesia for major lower limb amputation.

This study describes the methods of anaesthesia and analgesia used in 349 major lower limb amputations for vascular disease over a seven year period (1992-8). The main type of anaesthesia was general in 55%, spinal in 29%, and epidural in 14%: there were no significant differences for ASA grade, age, or amputation level, nor any statistical differences in mortality for each method of anaesthesia. The main methods of analgesia in the first 48 hours changed between 1992 and 1998, with decreasing intramuscular and oral opioids (from 38% to 7%, and from 23% to 2% respectively) while epidurals became the commonest method (4% in 1992 and 63% in 1998). Thirty seven percent of patients were prescribed carbamazepine for phantom pain. There have been substantial changes in postoperative analgesia following amputation, and epidurals are now common practice, despite the controversy about their role in preventing phantom pain.