The Effectiveness of Post-operative Analgesia in Caesarean Section Patients at King Dinuzulu Hospital Complex: A Prospective Qualitative Descriptive analytical study at a District level Hospital in  South Africa.

Tatum Curtis; Shree  Singaram

doi:10.51168/sjhrafrica.v6i3.1526

Authors

Dr. Tatum Curtis UKZN Department of Anaesthetics and Critical Care
Dr. Shree Singaram Discipline of Anesthesiology and Critical Care, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, 719 Umbilo Road, Berea 4001, Durban, South Africa

DOI:

https://doi.org/10.51168/sjhrafrica.v6i3.1526

Keywords:

Post-operative pain, caesarean section, analgesia, spinal anesthesia, pain management, pain scores, district hospital, King Dinuzulu Hospital

Abstract

Background:

Post-operative pain management in caesarean section (C-section) patients is crucial for optimal recovery. However, pain control in district-level hospitals, such as King Dinuzulu Hospital Complex in KwaZulu-Natal, often faces challenges due to resource limitations and variability in clinical practices. The study aimed to assess post-operative pain management following spinal anaesthesia in women receiving a caesarean section. The main objective was to assess a patient's pain level at specified time intervals post-operatively – therefore evaluating the adequacy of the post-operative analgesia prescribed and administered in decreasing a patient’s pain level.

Methods:

This prospective qualitative descriptive analytical study included 157 women undergoing elective C-sections under spinal anesthesia. Pain management effectiveness was assessed using patient questionnaires and visual analogue scales (VAS) at multiple time points post-operation.

Results:

The participants ranged in age from 18 to 44 years with a mean age of 30.5 years (SD = 5.54) and most of the participants were African (96.1%). The study revealed significant variability in analgesic prescriptions and administration, with many patients experiencing suboptimal pain relief. Despite a standard protocol, 29.9% of patients reported increased pain 24 hours post-surgery, highlighting inconsistencies in pain management practices.

Conclusion:

The findings underscore the need for standardized pain management protocols and improved training for healthcare providers to enhance patient outcomes.

Recommendations

The Authors recommend that healthcare workers should be trained on the latest postoperative analgesia guidelines for women coming for caesarean section. Pain should be regularly assessed in the postnatal ward and analgesia administered timeously.

References

Munsaka EF, Van Dyk D, Parker R. A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa. S Afr Fam Pract (2004). 2021;63(1):e1-e6.

Prempeh ABA, Duys R, de Vaal A, Parker R. Pain assessment and management: An audit of practice at a tertiary hospital. Health SA. 2020;25:1281.

Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain. 2011;152(10):2399-404.

Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, et al. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118(3):424-9.

Shahraki AD JM, Ghaedi S. Pain relief after cesarean section: Oral methadone vs. intramuscular pethidine. Journal of research in medical sciences. 2012;17(2):143-7.

QUINLAN JD MN. Cesarean Delivery: Counseling Issues and Complication Management. American Academy of Family Physicians. 2015;91(3):178-84.

Kehlet H HK. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62-72.

M. Size, et al. Pain management in developing countries. The Association of Anaethetist of Great Britian and Ireland. 2007;62:38-43.

Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: What is new? Indian J Anaesth. 2017;61(3):200-14.

Roofthooft E, Joshi GP, Rawal N, Van de Velde M, et al. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(5):665-80.

Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res. 2019;19(1):68.

“Part III: Pain Terms, A Current List with Definitions and Notes on Usage” (pp 209-214). Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk. ISAP Press, Seattle, 1994. http://www.iasp-pain.org.

The National Department of Health, South Africa: Essential Drugs Programme. Primary Health Care (PHC) Standard Treatment Guidelines and Essential Medicines List. 7th ed. South African National Department of Health;2020. Chapter 20.

Barash P, Cullen BF, Stoelting RK, Cahalan MK, Stock CM. Clinical Anaesthesia. Philadelphia: Lipponcott Williams & Wilkins; 2009.

Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail's Clinical Anaesthesiology; 2013; 5th ed. McGraw-Hill Education, LLC.

South African Society of Anaesthesiology Acute Pain Guidelines_2015, pg S3 https://painsa.org.za/wp-content/uploads/2016/07/SASA-Acute-Pain-Guidelines_2015.pdf