Evaluation of Postoperative Pain Control Following major Surgery at Mulago Hospital

Background: Postoperative pain following major surgery contributes greatly to postoperative morbidity and anxiety. This makes postoperative pain control a factor, not only in Africa but worldwide. Once postoperative pain is controlled adequately and effectively, the patient’s general condition and satisfaction are improved considerably, leading to early mobilization and shorter hospital stay. The main objective of the study was to evaluate the methods and practices of postoperative pain management, following major surgery in the department of Surgery at Mulago Hospital, with the aim of identifying the gaps that contribute to unsatisfactory postoperative pain control and highlighting the need for a pain management protocol.
Methods: This was a cross-sectional, observational and descriptive study of the patients undergoing laparotomy in the department of Surgery, over a 7-months period. Laparotomy was chosen to represent a common form of major surgery. Every patient who was included in the study was assessed and interviewed, at 6 hours and 24 hours postoperatively, using a pre-tested questionnaire. The Numerical Visual Analog Scale (labeled 1-10) was the tool used for pain assessment, for all the 132 patients in this study. The patients’ ages ranged from 18 to 70 years. The study variables included pain severity, type of analgesic, dosage, interval between doses, route of administration, while relating them to the operative procedure. Data was collected using a pre-tested Questionnaire, and analyzed using the SPSS version 10.0 software.
Results: The prevalence of postoperative pain among the 132 study patients was 100%. The commonest route of analgesics administration was by intramuscular injection, during the first 24 hours postoperative period. Pethidine was used in 58% of the cases. By 24 hours postoperatively 47% of the patients were on Diclofenac only. Whereas Pethidine offered better postoperative pain control than Diclofenac ( P=0.012), a combination of the two gave the best pain control. The mean pain scores for the different operative procedures were within the same ranges, without significant differences. The majority (53%) of the participants indicated that postoperative pain control was not satisfactory.
Conclusion: Postoperative pain was not adequately controlled following major surgery. There is need to review and improve the methods and practices of postoperative pain management, especially in the first 24 hours.