General considerations. Amputations can be performed under general or regional anesthesia. There is no mortality difference between regional and general anesthesia. Regardless, insertion of an epidural catheter or perineural block is typically recommended for postoperative pain control. Postoperative stump pain is effectively treated with either continuous perineural infusion of bupivacaine or epidural infusion of bupivacaine combined with an opioid.

Phantom limb pain (PLP) has been reported to occur in 60% to 70% of patients undergoing amputation. It is controversial whether the use of perioperative neuraxial anesthesia decreases the risk of development of chronic PLP. The literature suggests that good perioperative pain control, starting in the preoperative period and extending postoperatively, may be associated with a reduced incidence of PLP. Further studies are needed.