Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees - 22/08/11
, S. Topfner b, c, K. Wiech b, H.E. Schaller b, C.J. Konrad a, M. Schmelz a, N. Birbaumer b, d
Corresponding author. Address: Department of Anaesthesiology and Intensive Care Medicine, Experimental Pain Research/Pain Centre, University of Heidelberg, Faculty of Clinical Medicine, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Tel.: +49 621 383 4477/2608; fax: +49 621 383 3826.Abstract |
Background |
Hyperexcitability of N-methyl-d-aspartate acid (NMDA) receptors may play an important role in the development of phantom limb pain (PLP).
Aim of the study |
To investigate whether early treatment with the NMDA antagonist memantine attenuates phantom pain memory formation in traumatic amputees.
Methods |
In a randomized, double-blind, controlled trial 19 patients with acute traumatic amputation of the upper extremity were investigated. All patients received postoperative analgesia by continuous brachial plexus anesthesia (ropivacaine 0.375% 5ml/h) for at least 7 days. In addition, the patients received either memantine (20–30mg daily, n=10) or placebo (n=9) for 4 weeks.
Results |
Memantine treatment reduced the number of requested ropivacacine bolus injections during the first week and resulted in a significant decrease of PLP prevalence and intensity at 4 weeks and 6 months follow up, but not at 12 months follow up.
Conclusions |
We conclude that memantine can reduce intensity of phantom limb pain and might also prevent the development of PLP. However, despite the very early begin of treatment; no long-term effect on established PLP was evident.
Le texte complet de cet article est disponible en PDF.Keywords : Acute traumatic amputation, Continuous brachial plexus block, Deafferentation hyperexcitability, Glutamate antagonism
Plan
Vol 11 - N° 3
P. 299-308 - avril 2007 Retour au numéro
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