We were delighted to receive a very positive message from David Bosanquet, Vascular Surgeon at the Royal Gwent Hospital, Newport. David and his team received a Bader Grant towards research they were doing into post-amputation pain in 2015. We couldn’t be more pleased to announce that this initial enquiry has now been completed and published in the BMJ online; a terrific acknowledgement of the work and team effort that went into this painstaking research, the results of which will help understanding of the pain suffered by amputees and thereby how best to treat it.
You can click on the link at the bottom of the page to access the research.
David is now leading on another bit of amputation research looking at risk perception and decision making around the time of amputation. Amputation surgery is fraught with risks and the results of this latest investigation, which amongst other things will discover how good surgeons are at predicting surgery outcomes, should be helpful for people contemplating amputation.
The second part of this investigation will involve undertaking interviews with patients pre- and post-amputation the better to understand the reactions and needs of the amputees themselves; understanding which again could ultimately lead to better outcomes and more beneficial rehabilitation for the patients themselves.
You could also take part in discussion groups regarding further research.
Read on for David’s report and click on the link below the post to see the published research. Please do contact the team if you’d like to take part in future research or require any further information.
Pain immediately after amputation can be significant. We are a group of vascular surgeons, anaesthetists, and specialist medical researchers working in the Royal Gwent Hospital, Newport, and at the Centre for Trials Research, Cardiff University, who have worked together on a piece of research trying to improve pain control after a major lower limb amputation.
Most patients undergoing an amputation have morphine as a pain killer. Morphine generally works very well, but people can get significant side effects from it. Some people have such bad side effects that they prefer to put up with the pain, rather than using morpine. In 2014 a small group of us got together with the aim of evaluating a surgical technique of reducing pain, and potentially reducing morphine requirements. The technique involves placement of a ‘Perineural Catheter’, a tiny tube placed alongside the major nerve at the time of amputation, through which local anaesthetic can be infused, for the first 5 days after surgery. Once complete, the tube is removed, just like any other surgical drain.
Doing medical research takes a long time. Right at the very start of the process, we approached the Douglas Bader Foundation. They gave us seed-corn funding of £250 to start the ball rolling. Two years later, we were awarded ~£225,000 for a 50-patient feasibility study to evaluate this technique. Having the support of the DBF during this process was invaluable – it ensured the funders that we were proposing research which was of genuine interest to amputees.
We are delighted to say this study is now complete and published online. A link to the article can be found below. We even had a chance to present these findings on BBC Radio Wales. As a feasibility study it provided a lot of new information on performing randomised trials to help people with amputations. This will help other researchers set up other trials with this population. It also showed that it would be feasible to perform a larger trial specifically to examine perineural catheters and we now plan to expand this to answer once-and-for-all if it really does work. The support of the DBF from the very start of this project was a huge help, and we are delighted to be able to share the success of this project with you.
Our group continues to work on research aimed at improving outcomes after amputation. We are due to hold a series of ‘discussion groups’, for amputees, and their family/carers, to tell us what areas they would like us to research. If you wish to get involved, please contact WaldronC@cardiff.ac.uk or contact us on 02920 687609.
The PLACEMENT team
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Tags: limb pain, post-amputation
- This article has been accepted for publication in BMJ Open following peer review and can also be accessed online at https://bmjopen.bmj.com/content/9/11/e029233.long