Carla Retroz Marques is an Anaesthesiology Consultant at Coimbra University Hospitals Centre. She completed her Graduation of Medicine at the Faculty of Medicine of the University of Coimbra (FMUC) (1985-1991). She did her Master's Degree in Anesthesiology and Pain Therapy from the University Of Coimbra (FMUC) and her Master's Degree in Palliative Care from the Faculty of Medicine of the University of Coimbra (FMUC). She is a Member of the Chronic Pain Clinic of Coimbra University Hospitals Centre. She gives Guidance Training In Anesthesiology And Pain Therapy.
Elective mutilating surgery is performed in extreme situations to avoid potentially life-threatening consequences inherent to the evolution of the underlying pathologies. The amputation of limbs constitutes, by itself, an important physical and psychological aggression with evident deformation of the self-image, interfering widely in standard social integration and rehabilitation to daily activities. Dramatically, it can also be associated with moderate to severe chronic painful sensations that significantly interfere with quality of life (QoL).
Phantom Limb Pain (PLP) is the designation of a chronic neuropathic pain syndrome with phantom awareness of an amputated limb in which a noxious sensation prevails where the limb existed. It is extremely difficult to control, refractory to conventional therapies, and remains a challenge for the anesthesiologist. It represents a high socio-economic burden with a prevalence of 60-80% worldwide and remains controversial due to its complexity and the inexistence of established multidisciplinary protocols.
It is, therefore, essential that appropriate prophylactic and therapeutic measures are taken and disseminated to seek to minimize this scourge of significant human, clinical, and socioeconomic dimensions. For this purpose, an investigation based on the pathophysiology of pain was carried out to allow the elaboration of a multimodal protocol for the relief of pre-surgical ischemic pain, acute postoperative pain, and for prophylaxis of phantom limb pain. Multimodal Prophylactic Protocol (MPP) was designated as an interdisciplinary protocol to promote analgesia throughout the perioperative period and prophylaxis of PLP, improving quality of life and decreasing social and economic costs.
This original protocol consisted of Continuous Epidural Analgesia pre and post-surgery procedure, with concomitant administration of Tricyclic Antidepressants and Anticonvulsive agent. The methodology was the establishment of a multimodal prophylactic protocol between the Chronic Pain Unit and Surgical Departments, with the cooperation of the Anaesthesiology Department, to ensure efficient analgesia before limb amputation and to prevent the later development of chronic pain syndromes.