TY - JOUR ID - 104266 TI - Pain Management in a Case of Severe Electrocution Injury and Resultant Quadruple Amputation JO - Trauma Monthly JA - TM LA - en SN - 2251-7464 AU - Guo, Shigong AU - Moiz, Munim AU - Henderson Slater, David AD - Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK Y1 - 2019 PY - 2019 VL - 24 IS - 6 SP - 5 EP - 8 KW - Pain KW - analgesia KW - Amputation DO - 10.30491/tm.2019.104266 N2 - Background: A 33-year-old patient presented to the Oxford Centre for Enablement for rehabilitation following severe electrical burn injuries requiring bilateral below elbow amputations, right below knee amputation and a left midfoot amputation. Specific issues: Chronic pain at the amputation sites as well as phantom limb initially proved challenging to manage medically however were eventually controlled with careful consideration of analgesic regimens. Pain was measured using the Numeric Pain Rating Scale. A likely attributing cause for the pain was peripheral neuropathy. Management: A combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used. Implications: Rigorous search strategies were created which interrogated the MEDLINE, EMBASE, CINAHL, PsycINFO databases for studies reporting limb pain management in electrocution injuries. A total of 841 studies were found with 583 screened after removal of duplicates. No RCTs could be identified investigating limb pain management in electrical injuries. Case reports and case series have described various treatment options including nerve blocks, neuropathic analgesia, physiotherapy, botulinum toxin, fracture fixation and even the use of Virtual Reality headsets.  We discuss this available evidence. No consensus exists as to the optimum management approach of pain in such patients. From our experience with this patient we suggest that a multi- modal analgesic approach is likely to be needed in such patients and should therefore be considered. Level 1 research into pain management in electrocution injuries is required. UR - https://www.traumamon.com/article_104266.html L1 - https://www.traumamon.com/article_104266_309587e9d6cc8b9574846f24cf47e7f2.pdf ER -