Rizzoli: Room to Improve?
Peri-operative Management of Patients Undergoing Major Limb Amputation:
A Clinical Audit at Rizzoli Orthopaedic Institute
Abstract
Phantom Limb Sensation (PLS), Phantom Limb Pain (PLP), and Residual Limb Pain (RLP) are common and clinically significant complications in patients undergoing major limb amputation, with a substantial impact on quality of life and the rehabilitation process. The peri-operative management of these conditions remains a therapeutic challenge, as there is still no clear consensus on the most effective preventive and treatment strategies.
The aim of this study was to evaluate the peri-operative management currently adopted at the Rizzoli Orthopaedic Institute in patients undergoing major upper and/or lower limb amputation, comparing it with the recommendations outlined in the institutional care pathway (“PDTA for patients undergoing lower limb amputation”), in order to conduct a clinical audit and identify potential areas for improvement.
A retrospective observational study was conducted on patients who underwent major amputation between 1 January 2023 and 31 December 2024. Demographic and clinical data were collected, including information on preoperative pain, intraoperative and postoperative anaesthetic and analgesic management, opioid and gabapentinoid consumption during the first five postoperative days, as well as the occurrence of PLS and PLP. A telephone follow-up was also performed to assess the persistence of RLP, PLS and PLP, the use of pharmacological and non-pharmacological treatments, adherence to the rehabilitation pathway, and patients’ subjective perception of quality of life.
The results showed substantial adherence of clinical practice to both the available literature and the institutional care pathway recommendations, particularly regarding the use of multimodal and loco-regional analgesic strategies. However, several areas for improvement were identified, especially in relation to the optimisation of preventive interventions and long-term follow-up. Furthermore, the observation of different patterns within specific patient subgroups, such as those undergoing amputation due to post-traumatic conditions, suggests the possible existence of distinct risk profiles that warrant further investigation. The relatively small sample size represents an additional limitation of the study.
Further prospective studies, involving larger patient populations and focusing on the prevention of chronic post-amputation pain, are needed to identify effective strategies to improve functional outcomes and quality of life in amputee patients.
