Peri‐operative management and analgesic strategy for a patient undergoing quadruple limb amputation

TL;DR

This paper discusses the successful management of a complex surgical case involving amputation of all four limbs and the use of a multi-modal analgesic strategy.

Contribution

The paper presents a novel peri-operative management approach for quadruple limb amputation using a combination of analgesic techniques.

Findings

A multi-modal analgesic approach including intravenous analgesics and nerve catheters was effective in managing postoperative pain.

The patient recovered well and regained independence with the help of prosthetics after 12 months.

Combining spinal and epidural techniques improved pain management outcomes.

Abstract

Inadequately managed amputation pain can contribute to postoperative morbidity and mortality. However, amputation pain can be challenging to manage due to its complex nature, with both central and peripheral nociceptive and neuropathic elements. Here, we present the case of a 47‐year old man who developed irreversible ischaemic injuries to all four limbs following admission to intensive care with sepsis. He required quadruple amputation and we describe our approach to his peri‐operative management including anaesthesia, invasive monitoring and the multi‐modal approach to his peri‐operative management using a combination of intravenous analgesics, bilateral brachial plexus nerve catheters and a combined spinal and epidural. The patient made a good recovery and was able to return home from a rehabilitation facility 12 months after the operation, able to undertake many tasks himself with the aid of prosthetics.