Post-operative Paediatric Pain Assessment and Management at a Tertiary Health Facility, Southern Nigeria: Surgeons’ Perspectives and Practice

Introduction: Whereas advances in perioperative care of children continue to be made with increasing evidence-based practice for postoperative analgesia, inadequate relief of postoperative pain resulting in significant morbidity and mortality is still being reported. Objective: To appraise surgeons' perspectives and practice of paediatric post-operative pain assessment and management at a tertiary health facility in southern Nigeria. Methods: In this cross-sectional survey carried out between September and December 2019, a semi-structured and self-administered questionnaire was distributed to surgeons/trainees in departments/units where paediatric patients undergo both major and minor surgeries. Their perspectives and practice of postoperative pain assessment and management were analysed using SPSS version 20.0. Results: Seventy-nine respondents completed the survey, including 19(24%) consultants, 32(40.5%) senior registrars, and 22(27.9%) junior registrars. Two-third of respondents (n=51, 64.6%) had more than 10 years working experience post-graduation. Involving parents/caregivers to assess postoperative pain was the most common strategy used by respondents (n=69, 87.3%), and most of them (n=67, 84.8%) do not make use of any pain assessment tools. Non-pharmacologic strategies for postoperative pain management were applied/prescribed sometimes (n=20, 25%) or rarely (n=20, 25%). Paracetamol and NSAIDs were the commonest non-opioid analgesics used while pentazocine was the commonly used opioid. Many respondents (n=66, 83.5%) had never prescribed morphine for postoperative analgesia in children. Seventeen percent of respondents do not prescribe postoperative analgesia to newborns. Conclusion: Findings of this study show that the practice in our institution falls short of the recommended multimodal approach to paediatric postoperative pain care. Development of standard protocols and training of providers of postoperative care are recommended.

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Postoperative pain documentation in a hospital setting: A topical review

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.12.010 ◽

2016 ◽

Vol 11 (1) ◽

pp. 77-89 ◽

Cited By ~ 6

Author(s):

Kristiina Heikkilä ◽

Laura-Maria Peltonen ◽

Sanna Salanterä

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Hospital Setting ◽

Postoperative Pain Management ◽

Assessment Tools ◽

Cochrane Library ◽

Topical Review ◽

Pain Documentation

AbstractBackground and aimsNursing documentation supports continuity of care and provides important means of communication among clinicians. The aim of this topical review was to evaluate the published empirical studies on postoperative pain documentation in a hospital setting.MethodsThe review was conducted through a systematic search of electronic databases: Web of Science, PubMed/Medline, CINAHL, Embase, Ovid/Medline, Scopus and Cochrane Library. Ten studies were included. Study designs, documented postoperative pain information, quality of pain documentation, reported quality of postoperative pain management and documentation, and suggestions for future research and practice improvements were extracted from the studies.ResultsThe most commonly used study design was a descriptive retrospective patient record review. The most commonly reported types of information were pain assessment, use of pain assessment tools, useof pain management interventions, reassessment, types of analgesics used, demographic information and pain intensity. All ten studies reported that the quality of postoperative pain documentation does not meet acceptable standards and that there is a need for improvement. The studies found that organization of regular pain management education for nurses is important for the future.ConclusionsPostoperative pain documentation needs to beimproved. Regular educational programmes and development of monitoring systems for systematic evaluation of pain documentation are needed. Guidelines and recommendations should be based on the latest research evidence, and systematically implemented into practice.ImplicationsComprehensive auditing tools for evaluation of pain documentation can make quality assessment easier and coherent. Specific and clear documentation guidelines are needed and existing guidelines should be better implemented into practice. There is a need to increase nurses’ knowledge of postoperative pain management, assessment and documentation. Studies evaluating effectiveness of high quality pain documentation are required.

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Assessment of postoperative pain management practices in Cameroon, Ivory Coast and Senegal: A multi-national survey

Tropical Doctor ◽

10.1177/00494755211016115 ◽

2021 ◽

pp. 004947552110161

Author(s):

Oumar Kane ◽

Narcisse Boua ◽

Romuald Hentchoya ◽

Modou Seck ◽

Amy N Fall ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Staff Training ◽

Management Practices ◽

Postoperative Pain Management ◽

Cross Sectional Study ◽

Cross Sectional ◽

Treatment Protocols ◽

Management Recommendations

Inadequately controlled postoperative pain impacts patients’ functional recovery and may affect the quality of life after surgery. Our multinational, cross-sectional study conducted online between November 2017 and January 2018 surveyed anaesthetists’ conformity with established postoperative pain control guidelines and looked at pain assessment, dissemination of information to patients, staff training and creation and use of treatment protocols. Of the 170 respondents, only six applied postoperative pain management recommendations. The proportion of respondents who reported regular staff training; the regular provision of pre-operative information to patients; the existence and use of written protocols; and the number conducting at least one pain assessment a day was not just suboptimal, but embarrassingly low.

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Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana

SAGE Open Nursing ◽

10.1177/2377960818790383 ◽

2018 ◽

Vol 4 ◽

pp. 237796081879038 ◽

Cited By ~ 1

Author(s):

Awube Menlah ◽

Isabella Garti ◽

Sarah Ama Amoo ◽

Confidence Alorse Atakro ◽

Caleb Amponsah ◽

...

Keyword(s):

Postoperative Pain ◽

Practical Knowledge ◽

Postoperative Pain Management ◽

Development Programs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

District Hospitals ◽

Knowledge Deficits ◽

Nurses And Midwives

Introduction There is documented evidence pointing to the fact that there are numerous challenges with postoperative pain (POP) management globally. However, these challenges with POP management are more profound in developing countries. Purpose The purpose of this study is to examine the knowledge, attitude, and practices of nurses concerning POP management in four selected district hospitals in Ghana. Methodology A descriptive, cross-sectional survey was employed to evaluate nurse's knowledge, attitude, and practices pertaining to POP management. Multistaged sampling was used to draw the respondents. An adapted version of the Nurses Knowledge and Attitudes Survey Regarding Pain instrument was used to test the knowledge, attitude, and practices of nurses and midwives. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study. Results This study showed that nurses in the four district hospitals had knowledge deficits regarding POP management. Eighty-one representing 48% of nurses had low knowledge on POP management. An overwhelming majority of nurses (97.6%) relied on routinely rendered basic nursing skills to relieve POP and a few used pharmacological interventions. However, nurses had good attitudes toward POP management. Conclusions POP is ineffectively managed by nurses in district hospitals in Ghana. Nurses and midwives in Ghana need to adhere to best practices in POP management by increasing their theoretical and practical knowledge, so that there will be tangible positive change in POP management in Ghana. Recommendations Nurses must be empowered through continuous development programs to keep abreast with changing trends that pertain to POP management.

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Perioperative analgesia and assessment of pain in children (literature review)

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(2)-26 ◽

2021 ◽

Vol 25 (2) ◽

pp. 329-335

Author(s):

O. S. Goncharuk

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Assessment ◽

Age Groups ◽

Postoperative Pain Management ◽

Assessment Tools ◽

Cochrane Library ◽

Perioperative Analgesia ◽

Pain Scales ◽

Nociceptive Responses

Annotation. Adequacy of postoperative analgesia and pain assessment remains a pressing issue in children. In order to provide effective pain management to this population, it is important to consider some specific features such as the age of a child, cognitive imparement, mechanisms of pain, and traumatic cimcumstances resulted in nociceptive responses. Therefore, it is essential for clinicians to be able to choose the appropriate tools for pain assessment in different age groups of children and clinical situations, and to interpret the obtained data correctly. Hence, our study aimed to systematize existing problematic aspects of postoperative pain assessment is children and to analyze the evidence on perioperative analgesia in the paediatic practice. For this purpose, we systematically searched MEDLINE, the Cochrane Library and Google Scholar for trials published between 2002-2020. We paid particular attention to the correct choice of pain assessment tools in children of different age groups, and proper interpretation of the data obtained. The study contains the updated recommendations for postoperative pain management in children. There is a special emphasis on priority of multimodal analgesia in children. Analysis of recent publications shows that newborns and children under 5 years of age should be assessed with comprehensive pain scales that include behavioral characteristics and physiological parameters. It is advisable to use self-assessment pain scales for children older than 5 years of age. In order to manage the acute pain effectively, it should be assessed at least every 4-6 hours. Sufficient perioperative analgesia promotes rapid rehabilitation and prevents children from postoperative homeostatic disruption.

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Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania

BMC Health Services Research ◽

10.1186/s12913-021-06686-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tumbwene Mwansisya ◽

Columba Mbekenga ◽

Kahabi Isangula ◽

Loveluck Mwasha ◽

Eunice Pallangyo ◽

...

Keyword(s):

Healthcare Workers ◽

Professional Training ◽

Health Workers ◽

Newborn Health ◽

Training Needs ◽

Assessment Tools ◽

Needs Analysis ◽

Maternal And Newborn Health ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract Background Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.

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Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

10.21203/rs.3.rs-39743/v3 ◽

2020 ◽

Author(s):

Betiel Yihdego Kidanemariam ◽

Traudl Elsholz ◽

Laban L. Simel ◽

Eyasu H. Tesfamariam ◽

Yonatan Mehari Andemeskel

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Health Care Providers ◽

Work Experience ◽

Statistical Significance ◽

Demographic Data ◽

Postoperative Pain Management ◽

Perceived Barriers ◽

Care Providers ◽

Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

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Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v7i1.735 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Ayodeji M. Adebayo ◽

Michael C. Asuzu

Keyword(s):

Health Facility ◽

Low Income ◽

Sampling Technique ◽

Simple Random Sampling ◽

Access To Health Services ◽

Cross Sectional Survey ◽

Self Medication ◽

Community Based ◽

Cross Sectional ◽

North West

Background: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities.Aim: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria.Settings: A low-income community in Ibadan North West Local Government Area of Oyo State.Methods:A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents’ sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05.Results: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF.Conclusion: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.

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Acute Pain Management

10.1093/med/9780190678333.003.0064 ◽

2018 ◽

Author(s):

Nihar Patel

Keyword(s):

Pain Management ◽

Acute Pain ◽

Pain Assessment ◽

Treatment Options ◽

Postoperative Pain Management ◽

Assessment Tools ◽

Age Appropriate ◽

Short And Long Term ◽

Inflammatory Drugs ◽

Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

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Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.1.34 ◽

2019 ◽

Vol 24 (1) ◽

pp. 34-38 ◽

Cited By ~ 2

Author(s):

Katherine Lemming ◽

Gary Fang ◽

Marcia L. Buck

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adverse Effects ◽

Dose Reduction ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Pediatric Population ◽

Postoperative Pain Management ◽

Nuss Procedure ◽

The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

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Venous thromboembolism in medical outpatients – a cross-sectional survey of risk assessment and prophylaxis

Thrombosis and Haemostasis ◽

10.1160/th10-03-0191 ◽

2011 ◽

Vol 105 (01) ◽

pp. 190-196 ◽

Cited By ~ 5

Author(s):

Holger Lawall ◽

Andreas Matthiessen ◽

Volker Hohmann ◽

Peter Bramlage ◽

Sylvia Haas ◽

...

Keyword(s):

Risk Assessment ◽

Venous Thromboembolism ◽

High Risk ◽

Medical Condition ◽

Assessment Tools ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Limited Mobility ◽

Substantial Risk ◽

Medical Outpatients

SummaryThe degree of thromboprophylaxis in medical outpatients is low despite a substantial risk for venous thromboembolism (VTE). This may be attributable to difficulties in assessing risk. Assessment tools like the Haas’ scorecard aid in determining the need for thromboprophylaxis. We aimed at evaluating how the use of this tool may aid physicians in appropriately using anticoagulants. This was an epidemiological, cross-sectional survey of acute medically ill patients with limited mobility treated by general practitioners and internists. Risk assessment for VTE by the treating physician was compared to calculated risk. Of 8,123 patients evaluated between August 2006 and April 2008, 7,271 fulfilled the in- and exclusion criteria. Mean age was 69.4 ± 13.6 years, and 45.2% were male. Of these 82.8% were high risk based on their acute medical condition, 37.9% based on their underlying chronic condition. Immobilisation, heart failure, pneumonia, age, obesity, and major varicosis were the most frequently encountered risk factors. The agreement between the Haas’ scorecard and physician indicated risk was high. At least 94.1% of patients with high risk received adequate anticoagulation mostly as low molecular weight heparins for a mean duration of 15.1 ± 30.5 days. There is a substantial risk for VTE in medical out-patients. Using a simple structured scorecard resulted in an overall appropriate risk assessment and high degree of anticoagulation. The scorecard may provide a tool to improve the overall awareness for VTE risk in medical outpatients, substantially improving the degree of prophylaxis in a patient population with largely underestimated risk.

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