Pain Management and Factors Associated with Its Severity among Post Surgical Patients Admitted in the Intensive Care Unit at Muhimbili National Hospital, Tanzania

Abstract

Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of <0.05 was considered significant. Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15-6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12-15.88, P value = 0.03) and thoracic surgeries (OR; 7.42, CI: 1.54-35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain.

The magnitude and associated factors of post-operative pain among adult patients

“…The American Society of anesthesiologist physical status classification of the patient was not a significant factor in the dependent factor in the present study and supported by Tanzania's study [ 47 ]. In contrast to our results, a study done in Chicago showed that POP was two times more likely to be experienced by those patients who were classified under ASA > II [ 48 ].…”

“…In our study perioperative use of analgesia was not significantly associated with factors with POP, it might be the half-life and duration of analgesia which was used in our hospital was not more than 90 min. However, preoperative use of analgesia was one of the factors of severe pain in another study [ 47 ].…”

Management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia. Prospective cross sectional study

“…Examples of arthritis that require this drug include osteoarthritis, rheumatoid arthritis, and many others. On the other hand, this study shows that 42.0% of opioids were used whereas 94.5% of opioids were used in Tanzania [ 7 ].…”

“…In Tanzania and Rwanda (KUTH and BUTH), the pharmacologic drugs prescribed postoperatively were 70.7% and 60.9% &9.3% pethidine, 11.4% and 83.9% &67.4% morphine, and 11.4% and 16.1% &27.9% fentanyl, respectively. Other analgesics used were paracetamol (60.2%, 72.4%, and 79.1%) and diclofenac (22%, 60.9%, and 62.8%, respectively [ 6 , 7 ]. According to a Ghanaian study, the prevalence of non-pharmacological postoperative pain management was 34.5%.…”

Postoperative Pain Management Practice and Associated Factors Among Health Professionals Working in Governmental Hospitals in South Wollo Zone, Ethiopia

“…The study in Tanzania indicates that the prevalence of patients who had postoperative severe pain within 24 and 72 hours were 30% and 40%, respectively. A study conducted in Saint Paulo's Hospital Millennium Medical College (SPHMMC) indicates that the magnitude of postoperative pain was greater than ninety percent, while in Mekele, the magnitude of moderate to severe pain among POP was greater than thirty percent [11][12][13].…”