Adequacy of analgesic practices among adult patients undergoing Laparotomy at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background: The prevalence of moderate to severe postoperative pain is estimated to be up to 100% in sub-Saharan Africa. Undertreatment is associated with physiological and psychological complications which can prolong recovery, lengthen hospitalization and add economic strain to patients and health care system. Adequate analgesia following surgery is generally considered when the visual analogue pain score (VAS) is ≤ 3. Faced with rising laparotomy rate at MTRH, lack of published data and absence of a procedure specific pain management guideline, the magnitude of acute postoperative pain and adequacy of analgesia practices remained unknown. Objective: To determine the adequacy of analgesia practices used in management of acute postoperative pain among adult patients who undergo laparotomy at MTRH, Eldoret, Kenya by establishing acute pain severity, identifying and evaluating the adequacy of pain-relieving modalities. Methods: The descriptive study was conducted among 241 participants who underwent laparotomy during the study period. The sample size was 241 people enrolled systematically. Participants were followed at different intervals including, at the postanesthetic care unit (PACU), at 24- and 48-hours. Data was collected through patients’ interviews, review of anesthetic charts and treatment sheets, to complete a structured questionnaire. The independent variables were demographic and clinical data (Elective/Emergency), types of analgesics and techniques of administration. The dependent variable of interest was pain severity. STATA version 16 software was used for analysis. Categorical data was summarized and findings presented in figures, corresponding percentages and tables. The study was conducted at 0.05 α level of significance. Pertinent ethical approvals were obtained. Results: The mean age of participants was 45.4 years with a female predominance. Majority of laparotomies were performed emergently (97.1%), with most common abdominal procedure being, exploratory laparotomy (41.9%). The proportion of patients with moderate or severe pain at PACU, 24 hours and 48 hours intervals, was 56%, 17% and 6.2%, respectively. The Conchran – Armitage test showed a statistically significant (P< 0.001) linear trend in pain score across the assessment periods. Paracetamol and tramadol were the most used combination at both 24 (31.1%) and 48 (28.9%) hours intervals. Conclusion: Postoperative pain management at MTRH is inadequate, as evidenced by many patients experiencing acute moderate to severe pain. A narrow range of opioid based systemic analgesics are used. Recommendation: Incorporation of additional interventions (such as adjuvant analgesics) and techniques (such as nerve blocks, epidural analgesia, cognitive behavioral therapy) with the goal of achieving VAS ≤ 3 post-operatively. Further research is needed to explore factors influencing post-operative pain management (comorbidities, anesthesia used, health care provider or system related factors).