Effect of preamputation lumbar sympathectomy on stump pain of lower limbs in patients of thromboangitis obliterans (Buerger′s disease)

Abstract

Background: Thromboangiitis obliterans (Buerger's disease) is a nonatherosclerotic inflammatory disorder primarily involving small and medium sized vessels, mainly arteries of the extremities. As the disease progresses, it could cause gangrene and amputation of limbs, eventually leading to persistent pain and disability. Settings and Design: A prospective, randomized, single-blinded comparative study. Materials and Methods: Fifty patients of Buerger's disease planned for amputation below the knee were divided randomly into two equal groups of 25 each. Patients of both groups were advised to stop smoking. Lumbar (chemical) sympathectomy was carried out in patients of study group 1 week before amputation. The severity of postamputation stump pain was assessed using visual analog scale (VAS) and requirement of analgesics on weekly basis for 12 weeks. The incidence of phantom limb pain and overall quality of life was also evaluated using Short Form-36 (SF-36) scale. Results: VASs and requirement of analgesics were significantly less in patients who underwent lumbar sympathectomy as compared to patients of control group. The quality of life as reflected by SF-36 score was also significantly better in the study group. However, there was no significant difference in the incidence of phantom limb pain in the two groups. No major complications were reported following lumbar sympathectomy. Conclusions: Lumbar sympathectomy significantly decreases the severity of postamputation stump pain of lower limbs and thus improves the overall quality of life in patients of Buerger's disease.