The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain.

We report the efficacy of perioperative infusion of clonidine and bupivacaine for above-knee amputation in a patient with a history of phantom limb pain in the same extremity after a previous below-knee amputation. The patient underwent general anesthesia. Before transection, the sciatic nerve was infiltrated with 0.25% bupivacaine 5 mL and clonidine 50 microg. After the nerve was severed, a 20-gauge epidural catheter was inserted into the nerve sheath and externalized laterally through a separate skin incision. Before closure, 0.25% bupivacaine 10 mL and clonidine 50 microg was injected, and 0.1% bupivacaine and clonidine two microg/mL was infused at 10 mL/h for the first 96 hours postoperatively. There were no incidents of hypotension, bradycardia, or sedation during the infusion period. The mean postoperative pain score (from 0 to 10) for 96 hours was 1.2 +/- 0.7. The patient required a total of 10 mg of oxycodone postoperatively. The patient did not report either stump or phantom pain for 12 months after surgery.