Limb Loss and Limb Difference Awareness Month 2024

-By Sarah Milosevic and Grace Young

April is Limb Loss and Limb Difference Awareness month. Losing a limb is a life-changing event. The number of people undergoing leg amputation surgery in the UK has risen from 3,260 in 2019 to 3,430 in 2022¹. This increase in the number of leg amputations performed has been highlighted as a cause for concern, given the impact that the loss of a limb has on patient well-being¹. Management of pain after leg amputation surgery can impact patient recovery, including their quality of life^2,3. Therefore, good pain management is important for favourable short- and long-term patient outcomes, including satisfaction with care, rehabilitation potential, and quality of life following leg amputation surgery⁴.

The Perineural Local Anaesthetic Catheter After Major Lower Limb Amputation Trial (PLACEMENT) has been designed for people undergoing leg amputation surgery with the help of our Patient and Public Involvement (PPI) Representatives. At the time of their leg amputation surgery, participants will be randomised to receive a perineural nerve catheter (PNC) or not receive a PNC. All participants will receive other pain management as needed. A PNC is a thin plastic tube, placed next to the main leg nerve which is dissected during amputation surgery. Participants randomised to have the PNC placed will have a local anaesthetic infused through the PNC for the first five days after leg amputation surgery. PLACEMENT will evaluate if the use of a PNC with local anaesthetic infusion affects the amount of pain participants experience compared to no PNC, and assess the effect of PNC use on participant satisfaction of pain management, and their recovery at 3 and 6 months, including chronic pain and quality of life. A sample of PLACEMENT participants will also be invited to be interviewed by our Qualitative Researchers. This will help us find out about their experiences of recovery following amputation (including the support they had or would have found useful), experiences of taking part in the PLACEMENT trial and experiences of and preferences for different methods of pain control.

Since opening for recruitment in October 2023, an advisory group of PPI members has been formed.  The PLACEMENT PPI Advisory Group met for the first time in February 2024, attended by six people with lived experience of amputation. Group members provided constructive feedback on questions for the trial patient interviews. Resulting improvements to the interview guide included simplifying questions relating to pain relief and adding questions about support and information following amputation. Information about life after amputation was highlighted as a key issue, and group members are keen to create an information resource for new amputees. After the meeting, the attendees of the first advisory group provided their feedback via an anonymous online questionnaire:

• The majority of the group felt that PLACEMENT had or would change based on their suggestions and input
• Group members felt that PLACEMENT was well-balanced in considering the needs of both researchers and patients
• Group members felt that all voices were listened to and debate was encouraged
• Group members felt that all comments were listened to and acted upon

The group will meet a further three times throughout the trial, and are looking for one or two additional members. If you know anyone who might be interested, please contact PLACEMENT PPI Lead Sarah Milosevic at MilosevicS@cardiff.ac.uk.

PLACEMENT update

As of 22^nd March 2024, 42 participants have been randomised from 6 active sites in Cardiff, Bristol, Swansea, London, Leicester, and Hull. The next sites to open will be in Basildon, Liverpool, Cambridge, and Newcastle upon Tyne. PLACEMENT is still open to new sites in the UK. For more information, email the trial team (placement-trial@cardiff.ac.uk), visit the trial website (https://www.placement-trial.co.uk/) or view the general information video on YouTube:

Resources for new amputees

There are several local and national charities and organisations who provide excellent resources of information for new amputees including:

• Limb Loss & Limb Difference UK https://www.limblosslimbdifference.co.uk
• The Limbless Association  https://limbless-association.org/
• Steel Bones  https://steelbone.co.uk/
• Finding Your Feet https://findingyourfeet.net/
• Limb Power https://www.limbpower.com/
• The Amputation Foundation https://amputationfoundation.org/
• I Am Possible Foundation https://iampossiblefoundation.co.uk/
• The Douglas Bader Foundation https://www.douglasbaderfoundation.com/

References

1. Waton S, Johal A, Li Q, Atkins E, Cromwell DA, Williams R, Harkin DW, Pherwani AD. National Vascular Registry: 2023 State of the Nation Report. London: The Royal College of Surgeons of England, November 2023
2. Torbjörnsson E, et al. Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease–a one-year follow-up. Disabil Rehabil. 2020;1–9
3. Brier MJ, et al. Quality of Relationships with Caregivers, Depression, and Life Satisfaction After Dysvascular Lower Extremity Amputation. Arch Phys Med Rehabil. 2018;99(3):452–8.
4. Jackson MA, Simpson KH. Pain after amputation. Contin Educ Anaesthesia, Crit Care Pain. 2004;4(1):20–3.