Postoperative Pain Assessment and Management in Pediatric Surgical Patients at Kigali University Teaching Hospital

Abstract

Background: Pain is a global health issue which may cause poor health outcomes. African children are so highly at risk to disease and injury, subsequently to pain. In the postoperative period, timely and accurate pain assessment is prerequisite to safe and effective pain management. However, pain can be difficult to assess in low and middle-income countries exceptionally in children. This put these particular patients vulnerable to pain and inadequate pain control. To date, there has been no research on postoperative pain management in pediatric surgical populations at Kigali University Teaching Hospital (KUTH). Objectives: The purpose of this research was to evaluate the level of postoperative pain assessment and management in pediatric surgical patients at KUTH. Methodology: This prospective cross-sectional study was carried at KUTH from July to November 2019. An IRB from UR-CMHS and KUTH was obtained and informed consent forms from participants were obtained before conducting the study. Pediatric surgical patients less than 15 years of age were eligible for inclusion. Participants were recruited before surgery and followed from the end of surgery until two days after surgery. Data was collected using a preestablished questionnaire and analyzed using SPSS 21. Results: Overall, 123 patients were recruited into the study. The median age was 6 years (IQR: 2.37, 11) and 90(73.2%) were male and 33(26.8%) were female. The majority of patients were from general surgery 50(40.7%) and the least number come from urology 6(4.8%). None of the patients were assessed for pain in their recovery room post-surgery, although, more than half of the patients 65(52.8%) spent between 1-4 hours there. In the ward, 69 (56.1%) of the patients received a pain assessment within 24 hours post-surgery. Among those who received the assessment, 35(50.7%) experienced moderate to severe pain within 24 hours post-surgery. All 123 patients were prescribed a postoperative analgesia with paracetamol being the most common. Nurses were compliant in administering patients prescribed analgesia 62.6% of the time. Conclusion: Pediatric Post-Operative Pain was found better assessed and managed in the ward than in recovery room with a significant difference of nurse compliance to the type of analgesia given.