Centre for Trials Research, Cardiff University, Cardiff, UK
Centre for Trials Research, Cardiff University, Cardiff, UK.
BMJ Open. 2021 Dec 1;11(12):e054618. doi: 10.1136/bmjopen-2021-054618.
To explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation.
Qualitative interview study, conducted as part of a randomised controlled feasibility trial.
Participants were recruited from two general hospitals in South Wales.
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 (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.
Semi-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.
Interviews 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.
Findings 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.
ISRCTN: 85710690; EudraCT: 2016-003544-37.
探索下肢大截肢术后患者对镇痛的体验、理解和认知。
定性访谈研究，作为一项随机对照可行性试验的一部分。
参与者招募自南威尔士的两家综合医院。
参与 PLACEMENT（下肢大截肢术后外周神经局部麻醉导管试验）的访谈参与者：一项比较外周神经导管（PNC）与标准护理用于下肢大截肢术后术后疼痛缓解的随机对照可行性试验。完成 5 天术后随访、能够且愿意进行面对面访谈、并同意接受联系的 PLACEMENT 参与者，有资格参加定性研究。共有 20 名参与者接受了 14 名参与者的半结构化面对面访谈：10 名男性和 4 名女性。
在两个时间点对参与者进行半结构化、面对面访谈：（1）截肢后 1 个月内和（2）至少 6 个月后。访谈以录音形式进行，逐字转录，并使用框架方法进行分析。
访谈揭示了 PNC 用于术后疼痛缓解的意外益处。与阿片类药物相比，参与者更看重这种局部、持续的镇痛模式。两组治疗参与者都对阿片类药物依赖和止痛药物副作用表示担忧，一些人报告说试图限制镇痛药的摄入量。
研究结果表明，下肢大截肢术后常规放置 PNC 可减轻术后疼痛，尤其是对术后谵妄风险较高的患者。这种镇痛方式还具有减轻术前焦虑、缓解疼痛管理负担和减少阿片类药物使用的潜力。未来的研究可以进一步研究患者控制镇痛和持续镇痛与患者对疼痛管理的焦虑和满意度之间的比较。
ISRCTN：85710690；EudraCT：2016-003544-37。
