The difference between the documented and perceived adherence to the pain management protocol in patients undergoing lower limb amputation

ISRCTN ISRCTN19372511
DOI https://doi.org/10.1186/ISRCTN19372511
ClinicalTrials.gov (NCT) Nil known
Clinical Trials Information System (CTIS) Nil known
Protocol serial number 201900820
Sponsor University Medical Center Groningen
Funder Universitair Medisch Centrum Groningen
Submission date
17/01/2021
Registration date
09/02/2021
Last edited
05/04/2022
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Surgery
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
In the Netherlands, approximately 3,300 lower limb amputations are performed annually. An amputation is a major intervention, which is associated with severe postoperative pain. Chronic postsurgical pain is only partly understood, difficult to treat and the effectiveness of treatment is limited. The severity and duration acute postoperative pain is associated with the risk of chronic pain. Preventive treatment should take place in the preoperative, intraoperative and in the first week of the postoperative phase with the aim of preventing long-term sensitization of the spine by blocking or modulating the nociceptive input after peripheral nerve damage. A perioperative pain management protocol for amputation has been introduced in the UMCG. This protocol describes the items and associated interventions of pain management that should be performed during the perioperative period of amputation. This protocol should be followed unless there are contra-indications in specific parts of the protocol.
The study aims to discover how this protocol was followed by patients.

Who can participate?
Patients who underwent amputation of the lower limb at the University Medical Center Groningen (Netherlands) (June 28, 2017 - February 1, 2020)

What does the study involve?
All patient records were analyzed to determine adherence to the perioperative pain management protocol (PPMP). To identify the perceived adherence to the PPMP a survey was also conducted among involved physicians.

What are the possible benefits and risks of participating?
None

Where is the study run from?
University Medical Center Groningen (Netherlands)

When is the study starting and how long is it expected to run for?
December 2019 to October 2020

Who is funding the study?
University Medical Center Groningen (Netherlands)

Who is the main contact?
Prof André P. Wolff, a.p.wolff@umcg.nl

Contact information

Prof André P. Wolff
Public

Department of Anaesthesiology, UMCG Pain Center
Location Beatrixoord Dilgtweg 5
Haren
9750 RA
Netherlands

ORCiD logoORCID ID 0000-0001-6240-3903
Phone +31 503612140
Email a.p.wolff@umcg.nl

Study information

Primary study designObservational
Study designRetrospecitve observational study
Secondary study designCase-control study
Study type Participant information sheet
Scientific titleDiscrepancy between the documented and perceived adherence to the perioperative pain management protocol in patients undergoing lower limb amputation. A retrospective observational study
Study objectivesThe adherence to the perioperative pain management protocol in patients who underwent a lower limb amputation is high
Ethics approval(s)Approved 10/12/2019, University Medical Center Groningen Institutional Review Board (PO Box 30 001, 9700 RB, Groningen, The Netherlands; +31 503614204; metc@umcg.nl), ref: METc 201900820
Health condition(s) or problem(s) studiedPatients who underwent a lower limb amputation
InterventionBetween June 1, 2017 and February 29, 2020, 153 lower limb amputations were performed. All patient records were analyzed retrospectively to determine the documented adherence to the perioperative pain management protocol (PPMP). To identify the perceived adherence to the PPMP a survey was also conducted among involved physicians.
Intervention typeOther
Primary outcome measure(s)

1. Documented adherence by patients to the perioperative pain management protocol measured from patient records by the researchers using a newly developed set of 11 adherence criterias at a single time point
2. Perceived adherence by physicians to the perioperative pain management protocol measured using a newly developed questionnaire completed by physicians at a single time point

Key secondary outcome measure(s)

Patient characteristics measured using patient records at a single time point:
1. Age, sex
2. Body mass index (kg/m²)
3. Comorbidities
4. Date of amputation, indication for amputation, region and level of amputation
5. Preoperative pain management, perioperative pain management
6. Medication usage
7. American Society of Anesthesiologists Physical Status (ASA score)
8. Anaesthetic technique, surgical complications
9. Length of hospital stay
10. 30-day mortality

Completion date01/10/2020

Eligibility

Participant type(s)Patient
Age groupAdult
SexAll
Target sample size at registration123
Total final enrolment123
Key inclusion criteria1. Patients who underwent transfemoral amputation, knee disarticulation, transtibial- and (partial) foot amputations, and whose data were registered in EPIC
2. Interns and residents in vascular surgery, vascular surgeons, residents in anaesthesiology and anaesthesiologists involved in the amputation process
Key exclusion criteria1. Patients younger than 18 years
2. Patients who underwent a toe amputation or a stump revision
3. Physician is no longer working in the hospital
Date of first enrolment01/06/2017
Date of final enrolment01/02/2020

Locations

Countries of recruitment

  • Netherlands

Study participating centre

University Medical Center Groningen
Pain center
Location Beatrixoord Dilgtweg 5
Haren
9750 RA
Netherlands

Results and Publications

Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
IPD sharing planThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Participant information sheet Participant information sheet 11/11/2025 11/11/2025 No Yes

Editorial Notes

05/04/2022: The intention to publish date was changed from 01/10/2021 to 31/12/2022.
09/02/2021: Internal review.
20/01/2021: Trial’s existence confirmed by University Medical Center Groningen