Evaluation of acute pain management in ambulatory herniorrhaphy during free surgical outreach in Akwa Ibom State, South-South Nigeria

Abstract

Surgical outreach Program is a platform where a large number of elective surgical patients are treated within a short time, usually on ambulatory basis by a volunteer surgical team at no cost to the patients. Inguinal hernia repair is usually the commonest procedure performed. However, acute postoperative pain associated with it is not often investigated in our environment.All adult patients with uncomplicated inguinal hernia who consented to the study were recruited. The choice of anaesthesia, surgical technique and postoperative analgesics used were as per the discretion of the individual surgical team members. Postoperatively, the patients were interviewed through a telephone call using a structured questionnaire for three consecutive days after the surgery. Data obtained were analyzed using SPSS version 16.A total of 43 patients, 34 males, 9 females were recruited. The mean age was 42.86 years. Local anaesthesia (LA) only was the commonest anaesthetic technique (42.2%), followed by LA + sedation (30.2%). Unimodal analgesic regimen as against multimodal regimen was used in 46.5% and 53.5% patients respectively. The incidence of moderate to severe pain was highest on the first day after surgery (72.5%), and it was statistically significant compared with No pain/mild pain (27.5%), p value = 0.002. More patients treated with unimodal compared with multimodal analgesic regimen had moderate to severe pain (56.7% vs 43.3%).Surgical outreach program is useful in reducing surgical disease burden. However, the incidence of acute moderate to severe postoperative pain is high (72.5%). Therefore, a standard protocol that is effectively communicated to all members of the surgical team must be developed in order to reduce this morbidity.