Objectives Inadequate postoperative pain control is common and is associated with poor clinical outcomes. This study aimed to identify preoperative predictors of poor postoperative pain control in adults undergoing inpatient surgery. Design Systematic review and meta-analysis Data sources MEDLINE, Embase, CINAHL and PsycINFO were searched through October 2017. Eligibility criteria Studies in any language were included if they evaluated postoperative pain using a validated instrument in adults (≥18 years) and reported a measure of association between poor postoperative pain control (defined by study authors) and at least one preoperative predictor during the hospital stay. Data extraction and synthesis Two reviewers screened articles, extracted data and assessed study quality. Measures of association for each preoperative predictor were pooled using random effects models. Results Thirty-three studies representing 53 362 patients were included in this review. Significant preoperative predictors of poor postoperative pain control included younger age (OR 1.18 [95% CI 1.05 to 1.32], number of studies, n=14), female sex (OR 1.29 [95% CI 1.17 to 1.43], n=20), smoking (OR 1.33 [95% CI 1.09 to 1.61], n=9), history of depressive symptoms (OR 1.71 [95% CI 1.32 to 2.22], n=8), history of anxiety symptoms (OR 1.22 [95% CI 1.09 to 1.36], n=10), sleep difficulties (OR 2.32 [95% CI 1.46 to 3.69], n=2), higher body mass index (OR 1.02 [95% CI 1.01 to 1.03], n=2), presence of preoperative pain (OR 1.21 [95% CI 1.10 to 1.32], n=13) and use of preoperative analgesia (OR 1.54 [95% CI 1.18 to 2.03], n=6). Pain catastrophising, American Society of Anesthesiologists status, chronic pain, marital status, socioeconomic status, education, surgical history, preoperative pressure pain tolerance and orthopaedic surgery (vs abdominal surgery) were not associated with increased odds of poor pain control. Study quality was generally high, although appropriate blinding of predictor during outcome ascertainment was often limited. Conclusions Nine predictors of poor postoperative pain control were identified. These should be recognised as potentially important factors when developing discipline-specific clinical care pathways to improve pain outcomes and to guide future surgical pain research. PROSPERO registration number CRD42017080682.

https://bmjopen.bmj.com/content/bmjopen/9/4/e025091.full.pdf

Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis

Background 
The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. In Africa, there are scanty data available that make use of multi-center data to characterize the quality of postoperative pain management. In this study using a longitudinal data, we have attempted to characterize the quality of postoperative pain management; among patients scheduled for major elective orthopedic, gynecologic and general surgery.


Methods 
This prospective longitudinal study evaluated the quality of postoperative pain management in patients undergoing elective general, gynecologic, and orthopedic surgery. We quantified the prevalence of moderate to severe postoperative pain with the International Pain Outcome Questionnaire and the corresponding adequacy of treatment with the pain management index. At four time points after surgery, we estimated pain severity, its physical and emotional interference, and patient satisfaction.


Results 
Moderate to severe postoperative pain was present in 88.2% of patients, and pain was inadequately treated in 58.4% of these patients. Chronic pain (β = 0.346, 95% CI: 0.212, 0.480) predicted patients’ worst pain intensity. Gender was not associated with the worst pain intensity or percentage of time spent in severe pain. Patient’s pain intensity did not predicted the level of satisfaction.


Conclusions 
The prevalence of moderate to severe postoperative pain and its functional interference is high in Ethiopian patients. The treatment provided to patients is inadequate and not in line with international recommendations and standards.

Quality of postoperative pain management in Ethiopia: A prospective longitudinal study.

Background Postoperative pain remains a challenge in the developed world, but the consequences of inadequately treated postoperative pain are particularly severe in low- and middle-income countries. Since 2011, reports have drawn attention to the poor quality of postoperative pain management in Ethiopia; however, our multicenter qualitative study was the first to attempt to understand the factors that are barriers to and facilitators of quality pain managment in the country. To this aim, the study explored the perspectives of patients, healthcare professionals, and hospital officials. We expected that the results of this study would inform strategies to improve the provision of quality pain management in Ethiopia and perhaps even in other low- and middle-income countries. Methods This study used a qualitative, descriptive approach in which nine healthcare professionals, nine patients, and six hospital officials (i.e. executives in a managerial or leadership position in administration, nursing, or education) participated in face-to-face, semi-structured interviews. Thematic data analysis was conducted, and patterns were explained with the help of a theoretical framework. Findings The barriers identified ranged from healthcare professionals' lack of empathy to a positive social appraisal of patients' ability to cope with pain. They also included a lack of emphasis on pain and its management during early medical education, together with the absence of available resources. Enhancing the ability of healthcare professionals to create favorable rapport with patients and increasing the cultural competence of professionals are essential ingredients of future pain education interventions. Conclusions Barriers to and facilitators of postoperative pain management do not exist independently but are reciprocally linked. This finding calls for holistic and inclusive interventions targeting healthcare professionals, patients, and hospital officials. The current situation is unlikely to improve if only healthcare professionals are educated about pain physiology, pharmacology, and management. Patients should also be educated, and the hospital environment should be modified to provide high-quality postoperative pain management.

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The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study.

Introduction There is documented evidence pointing to the fact that there are numerous challenges with postoperative pain (POP) management globally. However, these challenges with POP management are more profound in developing countries. Purpose The purpose of this study is to examine the knowledge, attitude, and practices of nurses concerning POP management in four selected district hospitals in Ghana. Methodology A descriptive, cross-sectional survey was employed to evaluate nurse's knowledge, attitude, and practices pertaining to POP management. Multistaged sampling was used to draw the respondents. An adapted version of the Nurses Knowledge and Attitudes Survey Regarding Pain instrument was used to test the knowledge, attitude, and practices of nurses and midwives. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study. Results This study showed that nurses in the four district hospitals had knowledge deficits regarding POP management. Eighty-one representing 48% of nurses had low knowledge on POP management. An overwhelming majority of nurses (97.6%) relied on routinely rendered basic nursing skills to relieve POP and a few used pharmacological interventions. However, nurses had good attitudes toward POP management. Conclusions POP is ineffectively managed by nurses in district hospitals in Ghana. Nurses and midwives in Ghana need to adhere to best practices in POP management by increasing their theoretical and practical knowledge, so that there will be tangible positive change in POP management in Ghana. Recommendations Nurses must be empowered through continuous development programs to keep abreast with changing trends that pertain to POP management.

https://journals.sagepub.com/doi/pdf/10.1177/2377960818790383

Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana.

// Juan Xin 1, * , Yabing Zhang 1, * , Leng Zhou 1 , Fei Liu 1 , Xiaoshuang Zhou 1 , Bin Liu 1 and Qian Li 1 1 Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China * These authors have contributed equally to this work Correspondence to: Bin Liu, email: liubinhxyy@163.com Qian Li, email: hxliqian@foxmail.com Keywords: dexmedetomidine; patient-controlled analgesia; QoR-15 Received: June 26, 2017     Accepted: October 04, 2017     Published: November 01, 2017 ABSTRACT Background: The Quality of Recovery-15 (QoR-15) is a patient-centered questionnaire to evaluate the recovery after surgery and anesthesia. Dexmedetomidine has sedative, analgesic, antiinflammatory and inhibitory sympathetic effects, which may contribute to early recovery. We hypothesized dexmedetomidine added to intravenous patient-controlled analgesia (PCA) could enhance the quality of recovery (QoR) in patients undergoing laparotomy surgery. Methods: In this randomized, double-blind, controlled study, 100 patients undergoing laparotomy surgery were randomly allocated into two groups: Dexmedetomidine (group D) and control (group S). Patients in the group D (n = 46) received dexmedetomidine 0.04 ug/(kg·h) plus sufentanil 0.02 ug/(kg·h) for 48 h after laparotomy surgery, and in the group S (n = 47) received sufentanil 0.04 ug/(kg·h) only. The QoR-15 scores, postoperative pain, rescue analgesia, recovery of gastrointestinal function, patient satisfaction and adverse effects were recorded. Results: The QoR-15 scores were significantly higher in the group D than in the group S on postoperative day (POD) 1, 2, 3 and 5 (P 0.05). The incidence of nausea was significantly lower in the Group D. No hypotension, bradycardia, or respiratory depression was observed. Conclusions: The addition of dexmedetomidine to PCA enhanced patient-centered recovery, reduced pain and adverse effect, and improved patient satisfaction after laparotomy surgery.

/pdf/effect-of-dexmedetomidine-infusion-for-intravenous-patient-1de89i4b6s.pdf

Effect of dexmedetomidine infusion for intravenous patient-controlled analgesia on the quality of recovery after laparotomy surgery.

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...

/pdf/acute-postoperative-pain-in-1-231-patients-at-a-developing-3p4xudhdaw.pdf

Acute postoperative pain in 1 231 patients at a developing country referral hospital: incidence and risk factors

Expediting red blood cell transfusions by syringing causes significant hemolysis.

Background: Cutaneous analgesia for venepuncture pain can be achieved using various topically applied local anaesthetic formulations. Xylocaine® 10% Pump Spray containing lignocaine hydrochloride a...

https://www.tandfonline.com/doi/pdf/10.1080/22201181.2018.1450200

Adriaan Albertus Murray

Papers

Acute postoperative pain in 1 231 patients at a developing country referral hospital: incidence and risk factors

Expediting red blood cell transfusions by syringing causes significant hemolysis.

Xylocaine® 10% Pump Spray as topical anaesthetic for venepuncture pain

Replacing the Anterior Mitral Valve Leaflet With Autologous Jugular Vein in a Sheep Model.