Temesgen Merga Haile, Brihanu Adamu, Teshome Zenebe Bekele
Department of Anesthesia, College of Medicine and Health Sciences, Ambo University, Ethiopia.
Department of Psychiatry, College Of Medicine and Health Sciences, Ambo, Ethiopia.
Ann Med Surg (Lond). 2022 Nov 24;84:104901. doi: 10.1016/j.amsu.2022.104901. eCollection 2022 Dec.
Post-Surgical pain should be consistently assessed and documented as vital signs as well as has to be better communicated and adequately managed accordingly. However, there is a limited study regarding pain assessment and management documentation in Ethiopia.
This study aimed to determine pain assessment documentation, pain management compliance with WHO guidelines, and its barrier.
A cross-sectional retrospective study design mixed with quantitative and qualitative study types was employed. Three hundred sixty-five Patient cards were reviewed from four public hospitals in the West Shoa zone; Central Ethiopia, as well as four key informants groups, were interviewed. WHO guideline was used to review the patient card and a semi-structured questionnaire was used to interview the key informants. Descriptive statistics were used to describe the socio-demographic characteristics; and pain characteristics, and texts, tables, and graphs were used to present the results. Data were analyzed using SPSS-20 and Data from the key informants was thematically analyzed.
From the total of 365 patient cards reviewed, it was observed that only for 189(51.8%) cases pain assessment was done within 48 h after Surgery. Out of the patient who had got pain assessment within 48 h the location of pain was explained in 93(25.5%) cases, pain quality was assessed in 128(35.1%) cases, and pain intensity tool was used in 169(46.3%) cases. Weak opioid (tramadol) is the most commonly described followed by Non-steroid anti-inflammatory drugs to relieve pain after surgery. Only 16(4.4%), patient card side effect was documented and the most reported side effect was Nausea and vomiting (13(3.6%). Lack of regular clinical audits for pain management, lack of technical updates on pain assessment and management as well as knowledge and attitude of health professionals toward pain management were the major barrier to effective pain management.
and recommendation: The pain assessment and documentation in the present study were slightly lower than in previous studies. There was a lack of clinical audit for pain management, a lack of refreshment/technical updates on pain assessment and management, and a lack of regulation of procurement for anti-pain medications. We recommend providing regular technical updates for health professionals and conducting a frequent clinical audit on pain management as well as a designing mechanism for easy availability of anti-paint medications, particularly strong opioids.
术后疼痛应像生命体征一样持续得到评估和记录，并且必须得到更好的沟通及相应的妥善管理。然而，埃塞俄比亚关于疼痛评估和管理记录的研究有限。
本研究旨在确定疼痛评估记录、疼痛管理对世界卫生组织指南的依从性及其障碍。
采用横断面回顾性研究设计，结合定量和定性研究类型。回顾了埃塞俄比亚中部西绍阿地区四家公立医院的365份患者病历，并对四个关键 informant 群体进行了访谈。使用世界卫生组织指南来审查患者病历，并使用半结构化问卷来访谈关键 informant。描述性统计用于描述社会人口学特征；疼痛特征，并用文本、表格和图表来呈现结果。数据使用SPSS-20进行分析，关键 informant 的数据进行主题分析。
在总共审查的365份患者病历中，观察到仅189例（51.8%）在术后48小时内进行了疼痛评估。在术后48小时内进行疼痛评估的患者中，93例（25.5%）解释了疼痛部位，128例（35.1%）评估了疼痛性质，169例（46.3%）使用了疼痛强度工具。弱阿片类药物（曲马多）是最常描述的，其次是非甾体抗炎药用于缓解术后疼痛。仅16例（4.4%）患者病历记录了副作用，最常报告的副作用是恶心和呕吐（13例（3.6%））。缺乏对疼痛管理的定期临床审核、缺乏疼痛评估和管理的技术更新以及卫生专业人员对疼痛管理的知识和态度是有效疼痛管理的主要障碍。
本研究中的疼痛评估和记录略低于先前研究。缺乏对疼痛管理的临床审核、缺乏疼痛评估和管理的更新/技术更新以及缺乏抗疼痛药物采购监管。我们建议为卫生专业人员提供定期技术更新，对疼痛管理进行频繁临床审核，并设计一种机制以便于获取抗疼痛药物，特别是强阿片类药物。
