{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:41:22Z","timestamp":1793104882713,"version":"4.5.0"},"reference-count":41,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Association of Anaesthetists of Great Britain and Ireland: Departmental Project Grant 2006","award":["No Grant Number"],"award-info":[{"award-number":["No Grant Number"]}]},{"DOI":"10.13039\/501100000317","name":"Action Medical Research","doi-asserted-by":"publisher","award":["AP1178"],"award-info":[{"award-number":["AP1178"]}],"id":[{"id":"10.13039\/501100000317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,1,30]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Randomised controlled trial of the effect of a perineural infusion of levobupivacaine on moderate\/severe phantom limb pain 6 months after major lower limb amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single-centre, UK university hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Ninety patients undergoing above-knee and below-knee amputation for chronic limb threatening ischaemia under general anaesthesia. Exclusion criteria were patients having surgery under neuraxial anaesthesia; inability to operate a patient-controlled analgesia device or complete a Visual Analogue Scale; amputation for trauma or malignancy; or contraindication to levobupivacaine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Either levobupivacaine 0.125% or saline 0.9% (10 mL bolus, infusion of 8 mL\/hour for 96\u2009hours) via a sciatic or posterior tibial nerve sheath catheter placed under direct vision during surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome measure was the presence of phantom limb pain, residual limb pain and phantom limb sensations up to 6 months after amputation. Secondary outcome measures included early postoperative pain and morphine requirements after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 81 participants were analysed; 6-month follow-up data were available for 62 patients. Pain and morphine requirements varied widely before and after amputation in both groups. The incidences of moderate\/severe phantom limb pain, residual limb pain and phantom limb sensations were low from 6 weeks with no significant differences between groups in phantom limb pain at rest (OR 0.56, 95%\u2009CI 0.14 to 2.14, p=0.394) or movement (OR 0.58, 95%\u2009CI 0.15 to 2.21, p=0.425) at 6 months. Early postoperative pain scores were low in both groups with no between-group differences in residual limb pain or phantom limb sensations (rest or movement) at any time point. High postoperative morphine consumption was associated with worsening phantom limb pain both at rest (\u221217.51, 95%\u2009CI \u221224.29 to \u221210.74; p&lt;0.001) and on movement (\u221218.54, 95%\u2009CI \u221225.58 to \u221211.49; p&lt;0.001). The incidence of adverse effects related to the study was low in both groups: postoperative nausea, vomiting and sedation scores were similar, and there were no features of local anaesthetic toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term phantom limb pain, residual limb pain and phantom limb sensations were not reduced significantly by perineural infusion of levobupivacaine, although the study was underpowered to show significant differences in the primary outcome. The incidence of phantom limb pain was lower than previously reported, possibly attributable to frequent assessment and early intervention to identify and treat postoperative pain when it occurred. There were large variations in postoperative pain scores, high requirements for analgesics before and after surgery and some problems maintaining recruitment and long -term follow-up. Knowledge of these potential problems should inform future research in this group of patients. Further work should investigate the association between perioperative morphine requirements and late phantom limb pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration numbers<\/jats:title>\n                    <jats:p>\n                      EudraCT 2007-000619-27;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN68691928\">ISRCTN68691928<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-060349","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T09:28:19Z","timestamp":1676021299000},"page":"e060349","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of a continuous perineural levobupivacaine infusion on pain after major lower limb amputation: a randomised double-blind placebo-controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn68691928","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-6431","authenticated-orcid":false,"given":"William","family":"Hunt","sequence":"first","affiliation":[{"name":"Division of Anaesthesia Critical Care & Pain Management, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mintu","family":"Nath","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia Critical Care & Pain Management, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK"},{"name":"Medical Statistics Team, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Bowrey","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia Critical Care & Pain Management, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK"},{"name":"Anaesthesia Critical Care and Pain Management, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Colvin","sequence":"additional","affiliation":[{"name":"Division of Population Health and Genomics, University of Dundee, Dundee, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Anaesthesia Critical Care & Pain Management, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK"},{"name":"Anaesthesia Critical Care and Pain Management, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"2025121605174279000_13.2.e060349.1","unstructured":"The Vascular Society . 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