Evidence map›Paper›PMID 40095222›Full record

SynthesisCurrent pain and headache reports2025

Perioperative Pain Management for Major Limb Amputation - A Systematic-Narrative Hybrid Review.

Floris V Raasveld, Seamus P Caragher, Nicolas Kumar, Carla H Lehle, Ahish Chitneni, Ian L Valerio, Kyle R Eberlin, David Hao

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Current pain and headache reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Floris V RaasveldDivision of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Seamus P CaragherDivision of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Nicolas KumarDepartment of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Carla H LehleHand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ahish ChitneniDepartment of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA.
Ian L ValerioDivision of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
Kyle R EberlinDivision of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
David HaoDepartment of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. david.hao@mgh.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPost-amputation pain, including residual limb pain (RLP) and phantom limb pain (PLP), can affect the outcome of surgery and have an impact on quality of life. Effective management of acute post-amputation pain requires a multidisciplinary approach with collaboration among the surgical and anesthesia teams to optimize pain management. A systematic-narrative hybrid review was conducted to assess and report the effectiveness of various interventions in perioperative pain management for amputation surgery.

methodsMEDLINE, Embase, CENTRAL, and ClinicalTrials.gov databases were searched for studies evaluating interventional and/or pharmacological approaches to managing perioperative pain in major extremity amputation surgery. The data collected included treatment options, average dosage and/or duration of treatments, and reported pain outcomes.

resultsOf the 27 studies evaluating interventions, 8 addressed neuraxial or perineural analgesia, 16 focused on peripheral nerve blocks (PNB), 2 examined peripheral nerve stimulators (PNS), and 1 investigated transcutaneous electrical nerve stimulation. Preoperative epidural analgesia was associated with a reduced incidence of postoperative pain. PNS, PNB, and catheter-based infusions were found to be effective in managing postoperative pain. The role of ketamine in treating post-amputation pain yielded mixed results, while other pharmacological agents, such as valproic acid and gabapentin, demonstrated limited efficacy.

conclusionsWhile numerous pain interventions are available, no single approach has been shown to be superior. A multimodal strategy, incorporating PNBs, preoperative pain control, and potentially ketamine, appears to provide the most comprehensive pain management strategy. Further long-term prospective studies are required to refine and optimize pain management techniques for major extremity amputation surgery. LEVEL OF EVIDENCE: III-Systematic reviews.

Indexed as

Amputation, SurgicalPain ManagementPerioperative CarePhantom LimbPostoperative PainHumansAcute PainAnesthesiaExtremity AmputationMultimodal

Identifiers

PMID40095222

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.