Wales could become a “centre of excellence” for amputation research

Currently, very limited research into amputations takes place despite 5,000 people in the UK every year going through the life-changing experience of losing a limb. And, with rates of diabetes set to rise - one of the leading causes of amputations - surgeons expect this number to increase.

Patients often describe their experience after amputation as a devastating time, they feel they have a loss of way of life, and can be in a lot of pain. The management of this pain is essential in the first days of recovery, but how best to manage it is not clear.

Research from the Centre for Trials Research, called the perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT), looked at a new way of managing pain following amputation surgery.

Consultant vascular surgeon, David Bosanquet, lead researcher on the PLACEMENT study said: “Having an amputation causes a lot of pain in itself, but these patients also get phantom pain which is when they feel pain in the foot that’s no longer there.”

Currently, morphine is used to manage pain after an amputation. Although it is a strong painkiller, there is a risk of serious side effects like morphine confusion and dependence.

“What we were researching was whether or not, as we do the amputation itself, we could insert a thin tube [called a catheter] next to the nerve that’s just been cut, bring it out away from the scar that we’re creating and put a local anaesthetic in it for five days. This had never really been properly researched before,” David explained.

The study team recruited 50 patients who were undergoing an amputation, and randomly selected half the patients to receive the new method of reducing pain, while the other half received the current standard treatment.

“The catheter looked as though it was working, but we need to do a bigger study to look at that in more detail. We found patients were happy and keen to be involved, we got our patient recruitment ahead of time.”

The feasibility study was funded through Health and Care Research Wales’ Research for Patient and Public Benefit (RfPPB) grant, which David described as “invaluable” to his research.

The next step will be to carry out a larger scale study on the use of catheters to reduce pain following amputation surgery. David is also planning research looking at the decision-making process around amputations and how well surgeons estimate the long-term outcomes of amputation surgery.

David concluded: “We try not to have to do an amputation. We try to do other operations to save legs, and we as surgeons tend to view amputation as a failure, so I think that’s why amputation research hasn’t attracted a lot of attention.

“I think that amputees are an under-researched population...I’m really hoping that Wales can become a centre of excellence for amputation research.”