OR Nurses....Phantom pain....is this true?

[DutchgirlRN, ASN, RN]

I have a patient who had a BKA. I have heard of and believe in phantom pain.

I was cleaning and redressing her stump and she jerked and said "oh it feels like you're tickling my toes". She said to me that the doctor told her that he saved the nerves from her leg, didn't sever them and pushed them back up into what was left of her leg and that the phantom pain comes from the nerves that used to be in the missing part of the leg now being in the remaining part of the leg.

Like I was literally tickling the nerves that used to be in her toes? This sounds so bizarre to me? Is this true? I've had alot of patients with phantom pain but I've never heard of this before. I'd love to know if this is true? Did she misunderstand her doctor?

[shodobe]

Patients will have phantom pain for years to come. Many patients I have had will tell me that they feel pain and touch as if they were feeling it at their feet. I believe it happens and I have been in the game for almost 30 years now. Mike

[DutchgirlRN, ASN, RN]

Patients will have phantom pain for years to come. Many patients I have had will tell me that they feel pain and touch as if they were feeling it at their feet. I believe it happens and I have been in the game for almost 30 years now. Mike

I don't doubt for a minute that phantom pain is real, that's not the issue. I want to know if the surgeon does save the nerves from the amputated portion of the leg and shove them up into the portion of the leg that is left? I think that sounds bizarre!

[Marie_LPN, RN, LPN, RN]

No, they don't save those nerves.

Typically when a BKA is done, or at least where i work, is for gangrene in the foot. The nerves in the foot are gangrenous, too, so if the nerves in the foot were to be saved and shoved into the portion that's left, that would be putting infected tissue into helathy tissue.

What's causing her sensations is the stimulation along the pathway of the leg nerves, were the sensory endings were in the amputated part.

[shodobe]

Marie is right. I guess I didn't answer you correctly. Surgeons will clamp off all vessels and nerves at the sight of the amputation. They normally only will keep a small portion of the nerve and this will be part of the skin flap that is used to cover the bone stump. Mike

[DutchgirlRN, ASN, RN]

Thanks Marie and Shodobe, That's pretty much what I thought. I could not imagine saving the nerves all the way to the foot. This pt had an amputation due to a blot clot in her calf. You both have explained it very well and I appreciate the education. I knew you OR people would have my answer. Thanks!

[spyder]

I had a good friend in college who was missing the lower part of his leg. He talked about the phantom feelings. He would talk about how his foot would itch at times.