BackgroundThere is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction.MethodsWe prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants’ pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants’ charts were reviewed for records of analgesics administered.ResultsPain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control.ConclusionAdequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.
This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively.
Burnout and related concepts such as resilience, wellness, and taking care of healthcare professionals have rightly become a very hot topic. This issue has come further into the foreground during the current COVID-19 pandemic, where issues such as occupational hazards, financial instability, lack of personal protective equipment, inadequate resources to manage patients, and process inefficiencies all threaten the well-being of frontline healthcare providers. 1 The number of published papers on burnout for doctors and nurses has dramatically increased over the last decade (Figure 1) and you would now have to read more than 4 papers a day to keep up with the literature. However, when looking at that body of literature, you could perhaps be forgiven for thinking that burnout is a "first world problem." Rotenstein and colleagues 2 published a landmark systematic review including any literature before 2018 that included any cross-sectional or longitudinal studies reporting the prevalence of burnout in physicians. From the 182 studies, including over 100 000
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