Processes and approaches to perioperative pain management in patients undergoing major lower extremity amputations secondary to vascular disease: a multi-specialty modified Delphi consensus study protocol

• Published in: BMJ open 2024-12, Vol.14 (12), p.e090289
• Main Authors: Ekkunagul, Thanapon, MacLeod, Caitlin Sara, Celnik, Anna, Chalmers, John, Thomson, Ross, Nagy, John, Forget, Patrice
• Format: Article
• Language: English
• Subjects: Amputation; Amputation, Surgical; Analgesics; Clinical medicine; Consensus; Delphi method; Delphi Technique; Diabetes; Drug Therapy; Humans; Kidney diseases; Lower Extremity - surgery; Narcotics; PAIN MANAGEMENT; Pain Management - methods; Pain Management - standards; Pain, Postoperative; Patients; Perioperative Care - methods; Perioperative Care - standards; Protocol; Regional anesthesia; Research Design; Surgeons; Surgery; United Kingdom; Vascular Diseases - surgery; VASCULAR SURGERY
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2024-090289

IntroductionPain surrounding major lower extremity amputations (MLEAs) in the vascular surgical patient can be severe, conferring significant debilitation from the preoperative stage through to the chronic rehabilitation phase. Although there is an evolving understanding of the array of existing analgesic medications and modalities, pain management in this context continues to be challenging. A previous report in the UK revealed that MLEA pain management practices may not be optimal from the perspective of patients. There are also limitations in the comprehensiveness and quality of existing evidence, and existing practices can be heterogeneous. Identifying effective pain management approaches in MLEA has thus been recognised as a key practice and research priority. Therefore, the aim of this study protocol will be to elucidate a multi-specialty view on the perceptions, processes and approaches to perioperative pain management in patients undergoing MLEAs secondary to vascular disease in the UK.Methods and analysisA modified Delphi methodology will be used to gain consensus among a UK-wide multi-specialty panel of clinical experts. At least three iterative rounds of structured anonymous electronic surveys will be circulated to a minimum cohort of 40 participants across relevant specialties. Expert agreement on pre-developed consensus statements pertaining to the approaches and techniques in MLEA pain management will be sought from the first round and quantified by a 5-point Likert scale. Quantitative and qualitative analyses will be performed to evaluate the level of agreement and participant feedback, respectively. A consensus criterion of ≥75% panellist agreement with a ≤10% between-round stability will be used for each statement. The process will be repeated with the results and implementation of feedback highlighted to panellists in each subsequent round.Ethics and disseminationEthical approval was not required for this study as the participants and methodology fall outwith the requirements for a National Health Service Research Ethics Committee review. The results will be disseminated in a peer-reviewed publication and presented at relevant conferences.