Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Background and Aims Due to closure and redirection of several vascular units in our area and our expertise in endovascular surgery, we experienced a large increase in our vascular surgery population in 2018. This came with high levels of acute pain on the ward. In 2019-2020 we audited anaesthetic and analgesic techniques via questionnaire. Regardless of anaesthetic or single shot nerve block, our rate of severe pain 24 hours after lower limb amputation was extremely high at 76%. We aim to eliminate severe(7-10) pain and have 80% of patients with good pain management(score 0-3) in order to start physiotherapy on day 1 postop.

Methods We recommended higher oramorph doses, anticipatory morphine prescribing, routine acute pain nurse review day 1 postop and routine surgical placement of sciatic or tibial nerve catheters with 10ml/h 0.125% levobupivacaine via epidural set and pain bomb. We also switched to an electronic notes system, where pain score 0-10 is regularly recorded with other observations. This year we used this to retrospectively audit pain in 108 patients (after 10 exclusions for lack of data).

Results 95 had nerve catheters, only 6(7.41%) had severe(7-10) pain and 71(74.74%) had good(0-3) pain control. 13 patients did not receive nerve catheters but pain management had still improved, with 2(15.38%) in severe pain and 7(53.85%) with good pain control.

Conclusions The difference between patients with and without nerve catheters did not reach statistical significance, but we continue to drive toward our short term goals and will later compare before and after rates of phantom limb pain.

Attachment audit approval email and carms registration.pdf