The PReliMinAry (Pain Relief in Major Amputation) Survey.

Abstract

OBJECTIVES\nMajor Lower Limb Amputation (MLLA) is associated with significant peri- and post-operative pain and has been identified as a research priority by patient and healthcare groups. The PReliMinAry survey was designed to evaluate existing MLLA analgesia strategies; identifying areas of equipoise and informing future research.\n\n\nMETHODS\nA targeted multi-national, multi-disciplinary survey was conducted via SurveyMonkey® (5/10/2020-03/11/2020) and advertised via social media and society email lists. The 10-questions explored pain-team services, pre-operative neuroleptic medication, pre-incision peripheral nerve blocks and catheters, surgically placed nerve catheters, post-operative adjunctive regimens, future research engagement and equipoise.\n\n\nRESULTS\n76 responses were received from 60 hospitals worldwide. Twelve hospitals(20%) had a dedicated MLLA pain team, seven(12%) had none. Most pain teams(n=52; 87%) assessed pain with a 0-10 numerical rating scale. Over half of respondents never preloaded patients with oral neuroleptic agents(n= 42/76; 55%). Forty-seven hospitals(78%) utilised patient controlled opioid analgesia. Most hospitals are able to provide pre-incision loco-regional peripheral nerve blocks, nerve catheters and surgical nerve catheters (95%, 77%, and 90% respectively), but use was variable. Ultrasound(US) guided peripheral nerve catheters were infrequently or never used in 57% of hospitals, whilst 23% infrequently or never utilise surgically placed nerve catheters.\n\n\nCONCLUSIONS\nThe survey revealed a preference towards single-shot nerve blocks and surgical catheters. A difference between the use of US guided nerve catheters and those surgically placed likely reflects the difference of literature evaluating these techniques. Most respondents felt there was equipoise surrounding future trials evaluating nerve blocks/catheters, but less so for surgical catheters.