Post operative pain therapy prescribing patterns and adequacy of post operative analgesia, at Muhimbili National Hospital Dar es Salaam Tanzania

Abstract

A study was done to observe the post operative analgesics, pattern of prescription and adequacy of post operative analgesia in patients undergoing major surgery in the surgical and gynaecological wards at Muhimbili National Hospital. The objectives of the study were to determine the pattern and adequacy of analgesia within 48 hours post operatively. Two hundred and fifty patients were recruited in the study. The prescribing patterns of post operative analgesics was recorded and each patient had to evaluate their pain perception by the use of a numerical visual analogue scale provided to them at 12, 24 and 48 hours post operatively. In this study all patients who had surgery were given post operative analgesics. Pethidine was the most frequently prescribed analgesic. Ninety eight percent of the patients received this drug. Only 2% received Diclofenac sodium as the only post operative analgesic. Fifteen percent received both Pethidine and Diclofenac sodium for post operative pain. Both analgesics were given parenterally. Most common prescription was parenteral pethidine 100mg at eight hourly intervals for 24 hours.

It was shown in this study that 60% of patients recorded the intensity of pain as severe to intolerable within the first 12 hours. In the second 12 hours the proportion of patients who rated their pain as severe to intolerable was 19% and mild to moderate was 76%. At 48 hours post operatively three percent of the patients rated their pain as severe to intolerable pain. Seventy six percent rated mild to moderate. Postoperative pain management was found to be inadequate at Muhimbili Hospital in

V1ll 98% of patients undergoing major surgery. It was observed that administration of analgesics was irregular. Most of the attending surgeons preferred prescribing pethidine at an eight hourly interval for 24 hours which was not the recommended frequency. In conclusion, the management of postoperative pain in Muhimbili National Hospital among surgical and gynaecological patients is inadequate. In an attempt to rectify the practice, there is need to update the knowledge of nurses and doctors on pain management.