Reassessment of acute postoperative pain in a resource limited burns unit after the implementation of an analgesic management plan

Greyling, Adriaan Johann (2017-12)

Thesis (MMed)--Stellenbosch University, 2017.

Thesis

ENGLISH ABSTRACT: Background Tygerberg Academic Hospital is the referral centre for all major burn wounds in adult patients in the Western Cape. Patients who underwent surgery for burns related injuries at Tygerberg Academic Hospital were identified as having a high incidence of moderate to severe postoperative pain in an audit done in 2012 when there was no fixed protocol for postoperative analgesia.1 In an attempt to reduce the incidence of moderate to severe postoperative pain, the Department of Anaesthesiology and Critical Care at Tygerberg Academic Hospital introduced a new postoperative analgesia protocol in the burns unit in November 2016. This is, according to our knowledge, the first unit in Tygerberg Academic Hospital where pain scores were introduced as part of routine vitals. Methods A five month interval after the introduction of the new protocol was allowed before an audit of patients’ pain experience was commenced. A sample of 64 patients that underwent burns related surgery was evaluated. Patients were asked to indicate on a printed visual analogue scale (VAS) the worst pain experienced in the first 24 hours postoperatively, as well as the amount of pain experienced at the time of the interview at 24 hours postoperatively. These values were compared to the data collected during the audit of 2012 to establish whether any improvement had been made. We considered a reduction in median VAS score of at least 18mm to be significant. Results In this study we could not prove a statistically significant difference between the control group of Murray and Retief from 2012 and the post-intervention group of 2017 in terms of pain outcome.

AFRIKAANSE OPSOMMING: Agtergrond Tygerberg Akademiese Hospitaal is die verwysingsentrum vir alle ernstige brandwonde van volwasse pasiënte in die Wes Kaap. Pasiënte wat chirurgie vir brandwondverwante beserings gehad het was geïdentifiseer om ‘n hoë insidensie van matig tot ernstige postoperatiewe pyn te hê in ‘n oudit wat gedoen was in 2012.1 Daar was op daardie stadium geen vasgestelde protokol vir postoperatiewe pynverligting nie. In ‘n poging om die insidensie van matig tot ernstige postoperatiewe pyn te verlaag, het die Departement van Anestesiologie en Kritieke Sorg in November 2016 ‘n nuwe protokol vir postoperatiewe pynverligting geloods in Tygerberg Akademiese Hospitaal se brandwonde eenheid. Hierdie is, sover ons kennis strek, die eerste eenheid in Tygerberg Akademiese Hospitaal waar pyntellings as deel van roetine observasies begin is. Metodes ‘n Vyf maande interval was toegelaat na die bekendstelling van die nuwe protokol voor ‘n oudit van pasiënte se pynervaring begin is. ‘n Steekproef van 64 pasiënte wat brandwondverwante chirurgie ondergaan het is geëvalueer. Pasiënte het op ‘n uitgedrukte Visuele Analoog Skaal (VAS) die ergste pyn ondervind in die eerste 24 uur na chirurgie, asook die pyn ervaar ten tye van die onderhoud teen 24 uur na chirurgie aangedui. Hierdie waardes is vergelyk met die waardes verkry tydens die vorige oudit in 2012 om te bepaal of enige verbetering plaasgevind het. Ons het ‘n verlaging in die mediaan VAS telling van ten minste 18mm aanvaar as noemenswaardig. Uitslae Ons was nie daartoe in staat om ‘n statisties noemenswaardige verskil tussen die kontrole groep van Murray en Retief van 2012 en die post-ingreepgroep van 2017 te bewys in terme van pynuitkomste nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108656
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