The efficacy of a simple standard multimodal analgesic protocol on acute post-operative pain after major abdominal surgery at Kenyatta National Hospital.
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Date
2013-04Author
Ondieki, Janai A. Mariita
Type
ThesisLanguage
enMetadata
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Background: Management of post-operative pain is regarded as routine in surgical
practice. Many studies have however shown that its management is often poor. Opioid
analgesics are most commonly used in treatment of moderate to severe pain after major
abdominal surgery. Intramuscular pethidine given in varying dosages has been shown to be
the most common analgesic used in Kenyatta National Hospital (KNH). This method has
received numerous criticisms from various authors. Multimodal analgesia is a strategy of
combining different classes of analgesics by various routes of administration to reduce side
effects of opioids and increase analgesic effect.
Objectives: To assess the effect of a standardized multimodal analgesic post-operative pain
management protocol in patients recovering from major abdominal surgery at KNH
Methodology: This was an age matched case control study of patients undergoing major
abdominal surgery in the General Surgical Wards at KNH. The cases were patients who
post-operatively received the study analgesic protocol of pethidine combined with
diclofenac. The control group consisted of patients whose post-operative treatment was a
single analgesic agent either an opioid or Non-Steroidal Anti-Inflammatory Drug (NSAID).
The study period was 3 months during which convenient (non-random) sampling was
utilized to enrol study participants meeting the enrolment criteria until the desired sample
size of 50 in each arm was attained. The main Outcome variables were pain scores
measured at rest in the first 72 hours using the Visual Analogue Scale and the incidence of
common opioid side effects i.e. nausea; vomiting and sedation. These were compared in the
two study arms. Data collected was entered and verified in Microsoft Excel and data
analysis performed using SPSS version 17.
Results: patients who received the study’s multimodal analgesic protocol had significantly
lower pain scores. Mean VAS score at 12 hours was 5.125 and 1.062 at 72 hours compared
with 6.175 at 12 hours and 1.66 at 72 hours. P value was <0.05. There was no significant
difference in the occurrence of sedation, nausea or vomiting between the two groups.
Citation
Janai A. Mariita Ondieki (2013). The efficacy of a simple standard multimodal analgesic protocol on acute post-operative pain after major abdominal surgery at Kenyatta National Hospital. A dissertation submitted in part fulfillment of the requirements for the Master of Medicine in General Surgery degree of the University of Nairobi.Publisher
University of Nairobi School of Medicine