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Continuous brachial plexus blockade in combination with the NMDA receptor antagonist memantine prevents phantom pain in acute traumatic upper limb amputees
Author(s) -
Schley M.,
Topfner S.,
Wiech K.,
Schaller H.E.,
Konrad C.J.,
Schmelz M.,
Birbaumer N.
Publication year - 2007
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2006.03.003
Subject(s) - memantine , medicine , nmda receptor , anesthesia , brachial plexus , placebo , antagonist , blockade , phantom limb , bolus (digestion) , amputation , surgery , receptor , alternative medicine , pathology
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.