Abstract
<jats:p>Introduction. Since the onset of the full-scale Russian–Ukrainian war, the number of patients with combat-related limb injuries in Ukraine has markedly increased, frequently resulting in amputations, repeated surgical interventions, and severe pain syndrome. Despite the substantial body of literature addressing post-amputation pain in civilian medicine, the management of acute post-amputation pain in the context of combat trauma remains insufficiently studied. This is due to differences in mechanisms of injury, a high incidence of direct nerve damage, infectious complications, and the staged nature of surgical treatment. Objective. To summarize and analyze current approaches to the management of acute post-amputation pain following combat trauma and to determine the feasibility of adapting the civilian evidence base. Materials and Methods. The study was conducted as a narrative review of the literature. Sources were identified through searches in PubMed, Scopus, and Web of Science. Additional publications available via Ovid, ScienceDirect, and Wiley Online Library were also analyzed, along with reference lists of relevant articles. The search strategy included combinations of keywords related to post-amputation pain, phantom limb pain, residual limb pain, combat trauma, regional anesthesia, and multimodal pain management. Initially, 50 studies were identified; following screening and eligibility assessment, 29 were included. Among them, 14 were randomized controlled trials, 7 observational studies, 7 case reports or case series, and 1 study published as conference proceedings. Results. Most of the included studies focused on phantom limb pain, whereas stump pain, residual limb pain, and phantom sensations were investigated considerably less frequently. The majority of studies were conducted in civilian populations, which substantially limits direct extrapolation of their findings to military patients. The greatest practical relevance for combat trauma settings is associated with studies of regional analgesia techniques, particularly perineural and epidural approaches. Prolonged peripheral nerve blocks are associated with reduced intensity of phantom limb pain and residual limb pain; however, this effect persists only during continuous infusion and gradually diminishes after discontinuation. Epidural analgesia demonstrates inconsistent findings: in some studies it improves early pain control, but it does not show a consistent effect on long-term post-amputation pain outcomes. Pharmacological approaches are characterized by even greater heterogeneity. Evidence regarding gabapentinoids is inconsistent, ranging from a lack of efficacy in randomized controlled trials to positive findings in individual studies. Similar variability is observed for ketamine. A considerable proportion of favorable outcomes has been reported in case reports or small case series, which limits their generalizability. At the same time, clinical practice in Ukrainian medical centers managing patients with combat trauma is based on a multimodal approach, including early administration of agents for neuropathic pain and active use of prolonged regional analgesia techniques. Conclusions. Adaptation of the civilian evidence base to the context of combat trauma is feasible but limited due to differences in injury patterns, the postoperative course, and the organization of care. This requires not direct transfer of approaches but their contextual reinterpretation. Priority in the management of acute post-amputation pain should be shifted toward early and continuous pain control. Thus, prolonged perineural analgesia appears to be the most relevant approach, whereas the effectiveness of epidural analgesia depends on the timing of initiation and duration of treatment. Pharmacological strategies should be applied within a multimodal framework, taking into account the risk of tolerance and the limitations of the available evidence. Hence, the management of acute post-amputation pain in patients with combat trauma requires the development of a distinct clinical strategy based on the principles of multimodal analgesia, sustained pain control, and adaptation rather than direct extrapolation of civilian approaches.</jats:p>