{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T04:32:41Z","timestamp":1766377961745},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T00:00:00Z","timestamp":1432598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2010limb 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\u00a0months 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\u2010limb amputation.<\/jats:p>","DOI":"10.1111\/papr.12307","type":"journal-article","created":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T13:54:05Z","timestamp":1432648445000},"source":"Crossref","is-referenced-by-count":7,"title":["Pain Management in Four\u2010Limb Amputation: A Case Report"],"prefix":"10.1111","volume":"15","author":[{"given":"Nafisseh S.","family":"Warner","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Mayo Clinic Rochester Minnesota U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Mayo Clinic Rochester Minnesota U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M.","family":"Moeschler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Mayo Clinic Rochester Minnesota U.S.A"},{"name":"Division of Pain Medicine Mayo Clinic Rochester Minnesota U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan C.","family":"Hoelzer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Mayo Clinic Rochester Minnesota U.S.A"},{"name":"Division of Pain Medicine Mayo Clinic Rochester Minnesota U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,5,26]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"1","article-title":"Ambulatory and inpatient procedures in the United States, 1996","volume":"139","author":"Owings MF","year":"1998","journal-title":"Vital Health Stat 13"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200708000-00003"},{"key":"e_1_2_5_4_1","first-page":"875","article-title":"Limb amputation and limb deficiency: epidemiology and recent trends in the United States","volume":"95","author":"Dillingham TR","year":"2002","journal-title":"South Med J"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.06.004"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(95)00133-6"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(88)90288-6"},{"key":"e_1_2_5_8_1","first-page":"324","article-title":"Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine","volume":"76","author":"Jahangiri M","year":"1994","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31820fc7d2"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)06315-0"},{"key":"e_1_2_5_11_1","first-page":"585","article-title":"A footplate for conventional PCA demand buttons","volume":"18","author":"Dawson P","year":"1990","journal-title":"Anaesth Intensive Care"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100790"},{"key":"e_1_2_5_13_1","first-page":"268","article-title":"PCA demand buttons","volume":"18","author":"Southall L","year":"1990","journal-title":"Anaesth Intensive Care"},{"key":"e_1_2_5_14_1","first-page":"121","article-title":"Postamputation pain: epidemiology, mechanisms, and treatment","volume":"6","author":"Hsu E","year":"2013","journal-title":"J Pain Res"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-011-9560-0"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12086"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0403200305"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(96)03080-1"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e3181685014"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpapr.12307","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.12307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T08:28:31Z","timestamp":1696148911000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.12307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5,26]]},"references-count":18,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2015,9]]}},"alternative-id":["10.1111\/papr.12307"],"URL":"https:\/\/doi.org\/10.1111\/papr.12307","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5,26]]}}}