Best Practices for Anesthetic Management and Analgesia for the Patient Undergoing Amputation.

This review article summarizes best practices for the anesthetic management and analgesia of patients undergoing limb amputation, populations in which acute stump pain and chronic phantom limb pain are highly prevalent. Organized across the perioperative continuum, it examines preoperative pain optimization and preemptive analgesia, intraoperative anesthetic technique selection and pharmacologic adjuncts such as ketamine and alpha-2 agonists, and postoperative regional and multimodal systemic analgesia. The authors also address long-term phantom limb pain through neuroplasticity-based retraining. They conclude that optimal care is multimodal, perioperative, and multidisciplinary, targeting both nociceptive and neuropathic mechanisms to improve short-term and long-term outcomes.