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Exploring patients’ experiences of analgesia after major lower limb amputation: A qualitative study

Milosevic, Sarah, Strange, Heather, Morgan, Melanie, Ambler, Graeme K, Bosanquet, David C, Waldron, Cherry-Ann, Thomas-Jones, Emma, Harris, Debbie, Twine, Christopher and Brookes-Howell, Lucy 2021. Exploring patients’ experiences of analgesia after major lower limb amputation: A qualitative study. BMJ Open 11 , e054618. 10.1136/bmjopen-2021-054618

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Abstract

Objectives: To explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation. Design: Qualitative interview study, conducted as part of a randomised controlled feasibility trial. Setting: Participants were recruited from two general hospitals in south Wales. Participants: Interview 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 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. Methods: Semi-structured, face-to-face interviews were conducted with participants over two time points: (i) up to one month, and (ii) at least six months following amputation. Interviews were audio recorded, transcribed verbatim and analysed using a framework approach. Results: Interviews revealed unanticipated benefits of perineural catheter 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. Conclusions: Findings suggest routine placement of a perineural catheter 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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Centre for Trials Research (CNTRR)
Medicine
Subjects: R Medicine > RD Surgery
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Date of First Compliant Deposit: 8 December 2021
Date of Acceptance: 9 November 2021
Last Modified: 14 Jan 2022 12:33
URI: http://orca.cardiff.ac.uk/id/eprint/145555

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