Post-operative Pain Management in Neonatal Patients at the Kenyatta National Hospital

Abstract

Background Proper detection, assessment and management of post-operative pain in neonatal patients is vital to mitigate poor outcome. In our setting various analgesic modalities are routinely used to control pain in neonates post-operatively, hence there is need to objectively determine the most efficacious agents, which will ultimately be recommended with evidence basis. Currently, no data exists on the current practice of controlling pain after surgery in neonatal patients at Kenyatta National Hospital. Study Objectives The primary aim of this study was to assess postoperative pain management in neonatal patients within the first 24 hours of surgery at the Kenyatta National Hospital. To achieve this we scored the level of pain in neonatal patients following surgery, determined the modalities used in post-operative pain management and then correlated the modalities used and the level of pain following surgery. Methods This was a cross-sectional hospital based study set in Kenyatta National Hospital. The CRIES score was used to assess the level of post-operative pain. Neonates with a score of ≤ 3 had no pain; those with > 3 had pain while those with > 6 had severe pain. Data was collected on the various modalities used for pain control and classified as single agent, bimodal or trimodal regimens. The data was analysed using SPSS 21.0, (Chicago, Illinois) to determine any co-relation between the modalities used and the level of pain following surgery. Fisher's exact tests was used to test bivariate relationships, with results concluded as significant at a P value <0.05 xiii

Results In this study, we enrolled eighty neonates. Thirty-one patients (39%) were pain free while 61% of patients had pain in the immediate postoperative period with only 5% having severe pain. The average pain score was 4 (SD= 1.1). The most efficacious regimen for pain control was trimodal analgesia with a combination of fentanyl, paracetamol and bupivacaine OR: 0.341 [0.108 – 1.081]. Bimodal analgesia with combinations including locoregional agents provided superior levels of pain control, specifically fentanyl and bupivacaine OR: 0.410 [0.141 – 1.192] and bupivacaine and paracetamol OR: 0.500 [0.192 – 1.299]. The least efficacious modality was a combination of fentanyl and paracetamol OR 0.635 [0.248 – 1.629] Conclusion Trimodal analgesia gave the best post-operative pain control, with analgesic combinations incorporating loco-regional agents providing superior levels of pain control. Recommendations Wider utilization of trimodal analgesic regimens incorporating loco-regional agents for post-operative pain control in neonatal patients. Additionally, we encourage the adoption of non-pharmacologic analgesic techniques in neonates that can act as a very effective adjunct to pharmacological modalities.