Pain Management in Four-Limb Amputation: A Case Report

Nafisseh S. Warner, Matthew A. Warner, Susan M. Moeschler, Bryan C. Hoelzer

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Acute pain following amputation can be challenging to treat due to multiple underlying mechanisms and variable clinical responses to treatment. Furthermore, poorly controlled preoperative pain is a risk factor for developing chronic pain. Evidence suggests that epidural analgesia and peripheral nerve blockade may decrease the severity of residual limb pain and the prevalence of phantom pain after lower extremity amputation. We present the perioperative analgesic management of a patient with gangrene of the bilateral upper and lower extremities as a result of septic shock and prolonged vasopressor administration who underwent four-limb amputation in a single procedure. A multimodal analgesic regimen was utilized, including titration of preoperative opioid and neuropathic pain agents, perioperative intravenous, epidural and peripheral nerve catheter infusions, and postoperative oral medication titration. More than 8 months postoperatively, the patient has satisfactory pain control with no evidence for phantom limb pain. To our knowledge, there have been no publications to date concerning analgesic regimens in four-limb amputation.

Original languageEnglish (US)
Pages (from-to)E76-E80
JournalPain Practice
Issue number7
StatePublished - Sep 1 2015


  • Acute pain
  • Epidural analgesia
  • Extremity amputation
  • Four-limb amputation
  • Ketamine
  • Peripheral nerve catheter
  • Phantom limb pain
  • Quadruple amputation
  • Residual limb pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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