Patient satisfaction with post-operative pain management and associated factors among surgical patients at Tikur Anbessa Specialized Hospital: Cross-sectional study.

Background: Patient satisfaction with postoperative pain management is a vital tool for measuring the quality of care in health centers, which associated with the care process and care outcome. There is still few evidence on factor for patient satisfaction with postoperative pain management. Objective: These study aimed to assess magnitude of Patient satisfaction with post-operative pain management and associated factors among surgical patients at Tikur Anbessa Specialized Hospital, from Feb 1- Apr 30, 2021. Method: Institutional based cross-sectional study was conducted among 335 adult patients using a systematic random sampling technique. Data were collected through structured questionnaires based on the modified APS-POQ to obtain responses from the patients. Both bivariable and multivariable logistic regression analysis was done to evaluate the association. P-value less than 0.05 was considered as statistically significant. Result: The find of this study revealed that 74.5% of patients were satisfied with overall pain management services. Patients with ASA I (AOR = 2.3; 95%CI: (1.06-5.08), received multimodal analgesics (AOR 4.30; 95% CI: (2.02-9.18), no perceived pain (AOR = 6.7; 95% CI: (1.54-29.7), had pain discussion (AOR = 8.9; 95% CI: (3.67-21.90) and waiting for analgesia service less than 30 min (AOR = 6.3; 95% CI: (1.34-29.58) were more satisfied. Conclusion: The study shows that patient satisfaction with postoperative pain management was low in our setup compared to many studies. Thus, there is a need to improve the quality of pain management services in the study area.

Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected public referral hospitals, Addis Ababa, Ethiopia: Cross sectional study.

Background: Fasting before anesthesia is mandatory in children to reduce the complications of regurgitation, vomiting, and aspiration during anesthesia and surgery. Prolonged fasting times have several negative implications in children, because high fluid turnover quickly leads to dehydration, hypotension, metabolic disturbances, and hypoglycemia, resulting in poor anesthetic outcomes. Aims: This study aimed to assess adherence to preoperative fasting guidelines and associated factors among pediatric patients undergoing elective surgery in Addis Ababa public hospitals in Ethiopia in 2020. Methods: A cross-sectional survey was conducted in Addis Ababa, which selected public hospitals in Ethiopia, in 2020. A total of 279 pediatric patients aged <17 years scheduled for elective surgery were included in the study. Data analysis was performed using SPSS V.21, and the values of the variables and factors were checked for associations using logistic regression. Statistical significance was determined at P -value of <0.05. The results are presented in text, tables, charts, and graphs. Results: A total of 279 pediatric patients responded to the analysis, with a 98.6% response rate. The majority of the participants (n = 251, 89.96%) did not follow the guidelines for preoperative fasting. The mean fasting time for clear liquids was 10 ± 4.03 (2-18 h) for breast milk 7.18 ± 2.26 (3.5-12 h), and for solid foods 13.5 ± 2.76 (8-19 h). The reasons for which the preoperative fasting delay was due to incorrect order were 35.1%, prior case procedures took longer times 34.1%, and changing sequence of schedule was 20.8%. Conclusion: Most children had prolonged fasting. The staff's instructions and schedules were challenged to follow international fasting guidelines.

The use of perineural dexamethasone and transverse abdominal plane block for postoperative analgesia in cesarean section operations under spinal anesthesia: an observational study.

BACKGROUND: During transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events. METHODS: This is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant. RESULTS: The time to first analgesic request was 8.5 h (8.39-9.79) in the TAPD group versus 5.3 h (5.23-5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05). CONCLUSION: An additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.

Lidocaine versus propofol administration on the attenuation of hemodynamic responses during extubation in the adult elective surgical patient: A prospective cohort.

BACKGROUND: Tracheal extubation is the process of removing a tube from the trachea. It is associated with an increase in heart rate, blood pressure, intracranial pressure, intraocular pressure, coughing, bronchospasm, laryngospasm, and bleeding. Many techniques, as well as drugs, have been attempted for attenuation of the airway and cardiovascular responses. Propofol and lidocaine are widely available drugs in resource-limited settings even though their relative effectiveness for smooth extubation is not well established. OBJECTIVES: To assess the effectiveness of intravenous lidocaine and propofol on the attenuation of extubation-induced hemodynamic responses in the adult elective surgical patient from November 01, 2019, to February 30, 2020, at Asella teaching and referral hospital, Ethiopia. METHODS: Institutional-based prospective observational cohort study design was conducted on 72 ASA I patients who underwent elective surgery. The study participants were allocated into three groups equally based on anesthetists' extubation plan; Group P, 0.5 mg/kg propofol, group L, 1.5 mg/kg lidocaine administered 2 min before extubation and group C was a control group. Data were analyzed by SPSS version 20 after the normality of the data was checked by the Shapiro Wilk test. One-way ANOVA followed by a Tukey posthoc test has been employed to find the pair-wise significance and a p-value of <0.05 was considered as statistically significant. RESULTS: A demographic status and clinical characteristics of the patient were comparable between groups with p-values of >0.05. After extubation; heart rate, systolic, diastolic, and mean arterial blood pressure were decreased significantly in groups of propofol and lidocaine within 10 min. Propofol shows better results in maintaining stable systolic blood pressure up to 3 min, while heart rate, diastolic, and mean arterial pressure were maintained stable up to 5 min after extubation (p = 0.001). CONCLUSIONS: 0.5 mg/kg propofol or 1.5 mg/kg lidocaine might help to attenuate extubation induced hemodynamic responses.