A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra

Khatib, Samina Khaliloddin; Razvi, Syed Shamim; Kulkarni, Sadhana; Parab, Swapnil Y

doi:10.4103/ija.ija_506_16

Cited by 9 publications

(10 citation statements)

References 23 publications

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“…In gynaecology surgery we have [30][31][32][33][34][35][36][37][38][39][40] Participants suggested this lack of policy-making power and influence contributed to increased anaesthetist workload and reliance on unqualified personnel, both of which affected quality.…”

Section: Doctors Need To Work Together For the Betterment Of The Heal...mentioning

confidence: 99%

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

Shahbaz

Zakar

Howard

2023

Preprint

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Background Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of quality anaesthesia services for surgical support in Pakistan’s Punjab province. Methods This qualitative study included 22 semi-structured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission representatives, and health department officials. We analysed data thematically, using deductive and inductive coding. Results We identified three themes of anaesthetist recruitment and retention, quality-of-care and in-service training, and discrepancies between specialities, describing major challenges experienced within the speciality. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance, and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety. Conclusions Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality, and ensuring availability of minimum essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon numbers, require that anaesthesiology graduates work a few years in-country (e.g. scholarship bonds), ensure in-service training attendance for skills updates, and implement quality assurance standards for equipment and supplies.

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Section: Doctors Need To Work Together For the Betterment Of The Heal...mentioning

confidence: 99%

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

Shahbaz

Zakar

Howard

2023

Preprint

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“…Emergency general surgery (EGS) is related to a worse acute postoperative pain compared to elective surgery [14][15][16][17][18]. Patient-and family-centered education is regarded as very important during the preoperative and postoperative periods [14,15,17,[19][20][21][22]. Telling patients how a drug is chosen, its properties and effects, understanding its side effects, and shared in the decisions helps reduce APP.…”

Section: Statementsmentioning

confidence: 99%

“…An accurate evaluation including psychiatric comorbidities, namely dementia and delirium, may facilitate APP management since pain assessment techniques in these conditions may be much more time-consuming [19,21,24]. Assessment tools that incorporate a behavioral component for pain scoring have demonstrated validity in patients with dementia [25].…”

Section: Statementsmentioning

confidence: 99%

“…The assessment of preoperative chronic pain is necessary because it is demonstrated that previous chronic pain history since may be associated to a worse APP [22]. Moreover, high APP pain level may lead to persistent postoperative pain [16,17,19,20,22,27].…”

Section: Statementsmentioning

confidence: 99%

“…18 General Surgery Department, Legnano Hospital, Legnano, Milano, Italy. 19 Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France. 20 Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland.…”

Section: Abbreviationsmentioning

confidence: 99%

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Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Coccolini

Corradi²,

Sartelli

et al. 2022

World J Emerg Surg

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Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.

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Pain management in cancer surgery: Global inequities and strategies to address them

Pellegrino,

Are

2023

Journal of Surgical Oncology

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Among patients undergoing surgical oncologic operations, patients in low‐ and middle‐income countries are at particularly high risk for inadequate perioperative analgesia. This article reviews some of the guiding pillars of pain management for cancer surgery, including use of regional analgesia and acute pain service consultation, multimodal adjunctive analgesia, and judicious opioid use while presenting data on international disparities for each pillar and proposing strategies to address these inequities.

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A multicentre survey of the current acute post-operative pain management practices in tertiary care teaching hospitals in Maharashtra

Cited by 9 publications

References 23 publications

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

Anaesthesia provision challenges in public hospitals of Pakistan’s Punjab province: a qualitative study of expert perspectives

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Pain management in cancer surgery: Global inequities and strategies to address them

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