scholarly journals Major lower limb amputation audit – introduction and implementation of a multimodal perioperative pain management guideline

2018 ◽  
Vol 12 (4) ◽  
pp. 257-258
Author(s):  
David C Bosanquet ◽  
Graeme K Ambler ◽  
Cherry-Ann Waldron ◽  
Emma Thomas-Jones ◽  
Lucy Brookes-Howell ◽  
...  
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Management Guideline ◽  
Perioperative Pain ◽  
Perioperative Pain Management

scholarly journals Major lower limb amputation audit – introduction and implementation of a multimodal perioperative pain management guideline

2018 ◽  
Vol 12 (4) ◽  
pp. 230-237 ◽  
Author(s):  
Hafiz Aladin ◽  
Adrian Jennings ◽  
Max Hodges ◽  
Alifia Tameem
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
National Guidelines ◽  
Management Guideline ◽  
Perioperative Pain ◽  
Pain Scores ◽  
Perioperative Pain Management

Lower limb amputation is a frequent surgical intervention. It is well known to be associated with postoperative pain. Optimisation of perioperative pain has been shown to reduce the risk of chronic pain. There are no national guidelines for the perioperative pain management of lower limb amputations. Following a baseline audit, we devised a multimodal perioperative pain management guideline, which included the insertion of a local anaesthetic perineural catheter. All patients undergoing an elective or emergency above, through and below knee amputation were reviewed prior and following the implementation of this guideline. Patient postoperative pain scores and opiate usage were analysed. One hundred and twenty-four patients were reviewed (68 patients prior to the implementation of the guideline and 56 patients following the guideline introduction). Following the implementation of the guideline, a greater proportion of patient’s pain scores were reported as 0 (i.e. no pain) compared to patients prior to its implementation (78% vs 61%). Pain scores were lower at all time intervals 6 days postoperatively following the guideline introduction. Statistically significant (Kendall’s tau-b analysis) (p < 0.05) reduction in pain scores was found upon admission to the ward, 6, 12, 24 hours and 2 days postoperatively. Fewer patients required the use of opioid patient controlled of analgesia after the guideline was introduced (26% vs 4%). The implementation of a perioperative pain management guideline improved pain scores and reduced opioid consumption in patients undergoing lower limb amputations. We suggest a holistic and collaborative, multimodal pathway towards the perioperative pain management of lower limb amputations.

scholarly journals Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Roberta De Jong ◽  
Alexander J. Shysh
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Multimodal Analgesia ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Multiple Sources ◽  
Limb Pain ◽  
Pain Mechanisms

Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

scholarly journals A LITERATURE REVIEW OF THE QUALITY OF LIFE, HEALTH STATUS AND PROSTHESIS SATISFACTION IN OLDER PATIENTS WITH A TRANS-TIBIAL AMPUTATION

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Stefano Brunelli ◽  
Cinzia Bonanni ◽  
Calogero Foti ◽  
Marco Traballesi
Keyword(s):  
Quality Of Life ◽  
Health Status ◽  
Pain Management ◽  
Literature Review ◽  
Lower Limb ◽  
Older Patients ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Inclusion Criteria

BACKGROUND: Several reviews have been published regarding quality of life (QoL) and Health Status (HS) in persons with lower limb amputation (LLA). However, little has been discussed in the literature with respect to older populations (i.e. age>60 years) with trans-tibial amputation. Furthermore, the perceived satisfaction with prosthesis is another important aspect for consideration in the amputees’ life. OBJECTIVE: The purpose of this review was to evaluate the impact of trans-tibial amputation on the QoL, HS and prosthesis satisfaction, in order to determine the appropriate intervention to improve these aspects in older population of trans-tibial amputees (TTA). METHODS: Research articles, published between January 2000 to March 2019, were found using Scopus, PubMed and Google Scholar databases. The methodological quality of the selected articles was assessed using the Critical Review Form-Quantitative Studies checklist. RESULTS: Ten articles that met the inclusion criteria were selected. In these papers, we can summarize that people with trans-tibial amputation have a better QoL compared to those with above knee amputation. Moreover, physical functioning and mobility are the most influencing factors for QoL and HS in older people with lower limb amputation. Finally, the prosthesis weight reduction may improve satisfaction with the prosthetic limb. CONCLUSION: Efforts have to be made in order to improve mobility in older population with transtibial amputation for better QoL and HS. This can be accomplished by means of adequate rehabilitation, pain management and an accurate choice of appropriate prosthetic components. We observed that the quality of evidence in the literature available is inadequate and future research would benefit from more prospective observational cohort studies with appropriate inclusion criteria and larger sample sizes to better understand the QoL and HS in this population. Layman’s Abstract: Few studies have deeply investigated the effect of aging on Quality of Life, perceived Health Status and satisfaction with the prosthesis on older trans-tibial amputees. This review focuses on these aspects, which can guide professionals on how to improve prosthetic and rehabilitative intervention in this particular amputees’ population. The results of this review indicate that the Quality of Life and Health Status seem to be influenced by adequate rehabilitation, pain management and an accurate choice of appropriate prosthetic components. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33640/26354 How To Cite: Brunelli S., Bonanni C., Foti C., Traballesi M. A literature review of the quality of life, health status and prosthesis satisfaction in older patients with a trans-tibial amputation. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.3. https://doi.org/10.33137/cpoj.v3i1.33640 Corresponding Author: Stefano Brunelli, MDSanta Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy.E-Mail: [email protected]: https://orcid.org/0000-0002-5986-1564

scholarly journals Continuous Regional Anesthesia Provides Effective Pain Management and Reduces Opioid Requirement Following Major Lower Limb Amputation

2014 ◽  
Vol 60 (5) ◽  
pp. 1406
Author(s):  
Oliver G.S. Ayling ◽  
Janice Montbriand ◽  
Jiao Jiang ◽  
Salima Ladak ◽  
Lindsay Love ◽  
...  
Keyword(s):  
Pain Management ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation

scholarly journals Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054618
Author(s):  
Sarah Milosevic ◽  
Heather Strange ◽  
Melanie Morgan ◽  
Graeme K Ambler ◽  
David C Bosanquet ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Qualitative Study ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Feasibility Trial ◽  
Limb Amputation ◽  
Face To Face ◽  
Randomised Controlled

ObjectivesTo explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation.DesignQualitative interview study, conducted as part of a randomised controlled feasibility trial.SettingParticipants were recruited from two general hospitals in South Wales.ParticipantsInterview participants were patients enrolled in PLACEMENT (Perineural Local Anaesthetic Catheter aftEr Major lowEr limb amputatioN Trial): a randomised controlled feasibility trial comparing the use of perineural catheter (PNC) versus standard care for postoperative pain relief following major lower limb amputation. PLACEMENT participants who completed 5-day postoperative follow-up, were able and willing to participate in a face-to-face interview, and had consented to be contacted, were eligible to take part in the qualitative study. A total of 20 interviews were conducted with 14 participants: 10 male and 4 female.MethodsSemi-structured, face-to-face interviews were conducted with participants over two time points: (1) up to 1 month and (2) at least 6 months following amputation. Interviews were audio-recorded, transcribed verbatim and analysed using a framework approach.ResultsInterviews revealed unanticipated benefits of PNC usage for postoperative pain relief. Participants valued the localised and continuous nature of this mode of analgesia in comparison to opioids. Concerns about opioid dependence and side effects of pain relief medication were raised by participants in both treatment groups, with some reporting trying to limit their intake of analgesics.ConclusionsFindings suggest routine placement of a PNC following major lower limb amputation could reduce postoperative pain, particularly for patient groups at risk of postoperative delirium. This method of analgesic delivery also has the potential to reduce preoperative anxiety, alleviate the burden of pain management and minimise opioid use. Future research could further examine the comparison between patient-controlled analgesia and continuous analgesia in relation to patient anxiety and satisfaction with pain management.Trial registration numberISRCTN: 85710690; EudraCT: 2016-003544-37.

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