Evaluation of pain control following laparotomy in Mulago Hospital.
Kiswezi, Ahmed K.
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Introduction Postoperative pain following major surgery contributes greatly to morbidity and anxiety, especially in the first 24 hours. If controlled adequately and effectively, the patient's general condition and satisfaction are improved considerably. In our situation, unlike in developed countries where PCA is the Gold standard, pain control depends on a number of factors namely: Analgesic prescription, Dose, timing between doses, availability of prescribed analgesics, and the route of administration. Objectives The main objective of the study was to evaluate our methods and techniques of pain management, with particular reference to postoperative pain following major surgery, with the aim of identifying the gaps that contribute to poor postoperative pain control in Mulago Hospital. Methods This study was cross-sectional and observational. Patients who had had laparotomy were assessed and interviewed 6 hours and 24 hours postoperatively. The Visual Analog Scale was the tool used for pain assessment, for all the studied 132 patients. Specific areas looked at included pain severity, choice of analgesics, dosage, interval between doses, route of administration, while relating them with the operative procedure Data was collected using pre-tested Questionnaires, edited, cleaned and analyzed with the assistance of an experienced Biostatician. Results The prevalence of postoperative pain among the 132 study patients was very high (100%). The commonest route by which analgesics were given was by intramuscular injection, during the study period of 24 hours. Pethidine was the commonest analgesic used (58%) by 6hours postoperatively, while by 24 hours postoperatively most of the patients were on Diclofenac (47%). Whereas Pethidine offered better postoperative pain control than Diclofenac, combining the two gave the best pain control. The mean pain scores for the different operative procedures were within the same ranges, without significant differences. The intervals between doses were faulty, often not marching with the prescribing instructions. Conclusion There is need to improve on our methods and techniques of postoperative pain management especially in the first 24 hours. Lack of a consistent uniform format for pain assessment on all the surgical firms, the widely spaced analgesic prescriptions, irregularities in timing of analgesic doses, and sometimes unavailability of the prescribed analgesics are some of the causative factors to address if improvement is to be realized on the quality of our postoperative management. There is need for flexibility of reason in prescribing analgesics to include shortening the intervals between doses, using analgesic combinations, or changing the route to (IV) for opiates. There is need for consistence in keeping the stocks of the commonly prescribed analgesics.