Research Articles (Anaesthesiology and Critical Care)

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Acute postoperative pain in 1 231 patients at a developing country referral hospital : incidence and risk factors
(Medpharm Publications, 2016) Murray, Adriaan Albertus; Retief, Francois Wilhelm
Background: Postoperative pain is poorly studied in developing countries. At a Western Cape referral hospital, it was aimed to determine the incidence of acute postoperative pain, to identify populations associated with a higher risk thereof (in order to guide resource allocation) and to investigate whether inexpensive analgesic modalities are currently utilised maximally. Methods: Patients completed visual analogue scales 24 h after surgery for pain immediately after surgery, maximum pain since surgery and current pain. The incidence of moderate or severe pain and median pain scores were calculated for each scale and for different patient populations. Post hoc logistic regression was performed. Morphine prescriptions were compared with the actual administration thereof. Results: Of 1 231 patients, 62% indicated their maximum pain as moderate or severe. Procedures with the highest incidences were caesarean section and lower limb orthopaedic surgery (> 80%). Younger age, female gender, emergency surgery, and surgery to the abdomen and lower limbs were associated with higher incidences. Patients experiencing moderate or severe pain received 46% of their prescribed morphine. Conclusion: In this institution, the incidence of postoperative pain is high as expected. Associations with postoperative pain are identified, which may guide resource allocation. At least one low-cost analgesic modality is currently underutilised.
Caudal block for analgesia after paediatric inguinal surgery
(Health & Medical Publishing Group, 1987) Payne, K.; Heydenrych, J. J.; Martins, M.; Samuels, G.
Two hundred and eleven children aged 1 - 5 years were studied after undergoing herniorrhaphy or orchiopexy. In 111 cases a caudal block was used for postoperative analgesia. This was administered immediately after induction of anaesthesia, using bupivacaine 0,25% plain (0,7 ml/kg lean body mass), and was successful in 100 patients. A mean analgesic level (± SE) of T9,9 ± 0,47 was achieved (range L2-T6). In 5 cases no block occurred and in 6 the level was below T12. The other 100 children acted as controls. Behaviour patterns were more restful in the caudal block group on awakening and less opiate was required during the first 5 postoperative hours. No complications resulted.
Epidural versus intramuscular pethidine in postoperative pain relief
(1983) Payne, K. A.
Twenty-one patients received epidural pethidine 0,75 mg/kg in 10 ml normal saline for postoperative analgesia. A control group of 20 patients received intramuscular pethidine 1,5 mg/kg. Respiratory and cardiovascular parameters in both groups were stable, and in both side-effects were similar and not serious. In the epidural group analgesia was more intense and of longer duration and the level of consciousness was better. Central depression was present in both groups but less so in the epidural group.
Increasing the labour epidural rate in a state hospital in South Africa : challenges and opportunities
(Informa UK Limited, trading as Taylor & Francis Group, 2017-11-21) Van Zyl, Stephanus F.; Burke, Jonathan L.
Background: A 2012 audit on labour epidural analgesia rates in Tygerberg Hospital (TBH) revealed that only 2.2% of labouring parturients received epidural analgesia. This unacceptably low number necessitated a dedicated epidural service that was subsequently initiated in June 2014 by the Department of Anaesthesiology and Critical Care to improve the quality of care in labouring patients. Methods: A retrospective follow-up audit was conducted from June 2014 to December 2015 and included data on epidural rates, indications, complications and patient satisfaction. Comparison was made with the 2012 data to evaluate the impact of change on care provided and to recommend future changes. Results: Labour epidural rates improved to 5.16% for the audit period, with 2014 and 2015 rates of 7.44% and 3.89% respectively. Daytime epidurals doubled in 2014/2015 and complication rates decreased from 32.3% in 2012 to 16%. Primary indications for epidural analgesia included pre-eclampsia, morbid obesity, primigravidity and cardiac conditions. Although 99.8% of the complications were minor and transient, one fatality was reported during the audit period. This mortality emphasises the importance of team training in every aspect of epidural analgesia, so that the desired increase in epidural rate is associated with safe practice. Conclusions: An important increase in epidural rates as well as a decrease in minor complications was observed. The fatality indicates that the expansion of the service should be accompanied by in-depth training of the entire team, so that the process becomes routine and complications are reduced. A fatal drug error, a ‘never event’, should not occur.
Intramuscular buprenorphine compared with morphine for postoperative analgesia
(Health & Medical Publishing Group, 1987) Payne, K. A.; Murray, W. B.; Barrett, H.
The postoperative analgesic efficacy of buprenorphine (Temgesic; R & C Pharmaceuticals) 0,004 mg/kg and morphine 0,15 mg/kg were compared in 60 patients, both agents given by intramuscular injection. According to patients, buprenorphine gave better analgesia. There was no difference in the number of analgesic injections the two groups received in the 24-hour postoperative period. Cardiovascular and respiratory system were not depressed by either drug. Side-effects were not marked, nausea being the most common in both groups. Morphine had a greater effect on the mood of patients. Buprenorphine proved a satisfactory analgesic for postoperative use by intramuscular injection.
Xylocaine® 10% pump spray as topical anaesthetic for venepuncture pain
(Taylor & Francis Group, 2018) Van Straten, A.; Murray, A. A.; Levin, A. I.
Background: Cutaneous analgesia for venepuncture pain can be achieved using various topically applied local anaesthetic formulations. Xylocaine® 10% Pump Spray containing lignocaine hydrochloride and 95% ethanol is exclusively recommended for mucosal anaesthesia. However, this formulation is readily able to penetrate skin. This study investigated whether topical pre-treatment with Xylocaine® 10% Pump Spray could facilitate analgesia for venepuncture. Methods: A single-centre, prospective, randomised, double-blind placebo-controlled trial was conducted. One hundred patients were enrolled. The control and intervention groups had 0.5 ml saline and 0.5 ml Xylocaine® applied for 20 min to preselected venepuncture sites. Pain associated with an 18-gauge cannula venepuncture was rated on an 11-point Numerical Rating Scale. A two-point or 30% reduction in pain would be deemed clinically significant. Results: Pain scores were lower (p = 0.001) in the Xylocaine® (median 2; 95% CI 2–3) than the saline (median 4; 95% CI 3–5) group. Moderate-to-severe pain occurred in fewer Xylocaine® (18%) than saline (42%) treated patients (relative risk 0.43, CI 0.22 to 0.48; NNT = 5). Conclusion: Topical Xylocaine® 10% Pump Spray pre-treatment provided a time-effective method of reducing venepuncture-associated pain.

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