{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:02:07Z","timestamp":1791536527558,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Major lower extremity amputations occurring secondary to vascular disease remain prevalent worldwide. Pain surrounding these procedures is complex, multifactorial and associated with poor functional and psychosocial outcomes. The evidence base informing pain management approaches in major lower extremity amputations remain largely heterogeneous and limited. This study aimed to establish procedure\u2010specific, multispeciality consensus on the ideal principles and practices required to optimise pain management for vascular surgical patients undergoing major lower extremity amputations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three\u2010round online modified Delphi consensus process was undertaken, with consultant anaesthetists and consultant vascular surgeons across the UK forming the expert panel. Structured statements were assessed on a 5\u2010point Likert scale against a strong consensus threshold of \u2265\u200975% ratings in agreement or disagreement, and a rating stability criterion of &lt;\u200910% change between rounds. Free\u2010text responses were thematically analysed at each round to iteratively modify or generate new statements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy\u2010two panellists participated in the study. Of the 44 consensus statements assessed, 32 reached strong consensus agreement. These included: shared cross\u2010speciality responsibility for pain management; the mainstay role of locoregional analgesia; use of perineural catheters; opioid\u2010sparing approaches; and protocolised decision aids with individualisation of analgesia. Barriers to practices identified included resource constraints and the paucity of direct evidence. There was non\u2010consensus in 12 statements, notably on pre\u2010amputation initiation of locoregional analgesia; ultrasound\u2010guided nerve catheter placement; and surgeon\u2010delivered regional analgesia. No statement reached strong consensus disagreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study provides the first procedure\u2010specific consensus, delineating agreed principles and preferred pharmacological and locoregional analgesic approaches to peri\u2010operative pain management in patients undergoing major lower extremity amputations. The areas of non\u2010consensus expose key uncertainties that may inform future research, service organisation and guideline development agendas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70107","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T05:09:56Z","timestamp":1766034596000},"page":"664-674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Peri\u2010operative pain management in major lower extremity amputation in vascular Surgery: a\n                    <scp>UK<\/scp>\n                    anaesthetic and vascular surgery Delphi consensus study*"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4959-0235","authenticated-orcid":false,"given":"Thanapon","family":"Ekkunagul","sequence":"first","affiliation":[{"name":"Epidemiology Group, Institute of Applied Health Sciences University of Aberdeen  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3839-352X","authenticated-orcid":false,"given":"Caitlin Sara","family":"MacLeod","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ninewells Hospital and Medical School  Dundee UK"},{"name":"Division of Cardiovascular and Diabetes Medicine University of Dundee  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Celnik","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3858-6468","authenticated-orcid":false,"given":"Alan J. R.","family":"Macfarlane","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Glasgow Royal Infirmary  Glasgow UK"},{"name":"School of Medicine University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2304-0489","authenticated-orcid":false,"given":"David","family":"Bosanquet","sequence":"additional","affiliation":[{"name":"South East Wales Vascular Network, University Hospital of Wales  Cardiff UK"},{"name":"Division of Population Medicine, School of Medicine Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3635-653X","authenticated-orcid":false,"given":"John","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ninewells Hospital and Medical School  Dundee 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