{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:28:11Z","timestamp":1765607291728,"version":"3.48.0"},"reference-count":59,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,10]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pain surrounding major lower extremity amputations (MLEAs) in the vascular surgical patient can be severe, conferring significant debilitation from the preoperative stage through to the chronic rehabilitation phase. Although there is an evolving understanding of the array of existing analgesic medications and modalities, pain management in this context continues to be challenging. A previous report in the UK revealed that MLEA pain management practices may not be optimal from the perspective of patients. There are also limitations in the comprehensiveness and quality of existing evidence, and existing practices can be heterogeneous. Identifying effective pain management approaches in MLEA has thus been recognised as a key practice and research priority. Therefore, the aim of this study protocol will be to elucidate a multi-specialty view on the perceptions, processes and approaches to perioperative pain management in patients undergoing MLEAs secondary to vascular disease in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A modified Delphi methodology will be used to gain consensus among a UK-wide multi-specialty panel of clinical experts. At least three iterative rounds of structured anonymous electronic surveys will be circulated to a minimum cohort of 40 participants across relevant specialties. Expert agreement on pre-developed consensus statements pertaining to the approaches and techniques in MLEA pain management will be sought from the first round and quantified by a 5-point Likert scale. Quantitative and qualitative analyses will be performed to evaluate the level of agreement and participant feedback, respectively. A consensus criterion of \u226575% panellist agreement with a \u226410% between-round stability will be used for each statement. The process will be repeated with the results and implementation of feedback highlighted to panellists in each subsequent round.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was not required for this study as the participants and methodology fall outwith the requirements for a National Health Service Research Ethics Committee review. The results will be disseminated in a peer-reviewed publication and presented at relevant conferences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090289","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T22:21:11Z","timestamp":1733264471000},"page":"e090289","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Processes and approaches to perioperative pain management in patients undergoing major lower extremity amputations secondary to vascular disease: a multi-specialty modified Delphi consensus study protocol"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4959-0235","authenticated-orcid":false,"given":"Thanapon","family":"Ekkunagul","sequence":"first","affiliation":[{"name":"Epidemiology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK"},{"name":"Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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 Cardiovacular and Diabetes Medicine, School of Medicine, University of Dundee, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Celnik","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrice","family":"Forget","sequence":"additional","affiliation":[{"name":"Epidemiology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK"},{"name":"Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK"},{"name":"IMAGINE UR UM 103, Montpellier University, Anesthesia Critical Care, Emergency and Pain Medicine Division, University Hospital Centre Nimes, Nimes, France"},{"name":"Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care Research Group, European Society of Anaesthesiology, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025121222255340000_14.12.e090289.1","unstructured":"The Vascular Society of Great Britain and Ireland . 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