Efficacy of post-operative analgesia practices for short stay open pediatric inguinal hernia repair at Kenyatta national hospital

Abstract

Background: The paediatric population is at risk of inadequate post-operative pain management due to physiological, psychological, age related factors and poor understanding that exists. Inguinal hernia surgery is among the commonest short stay procedures performed in the paediatric surgical unit at Kenyatta National Hospital (KNH). Currently, no published data exists on adequacy of post-operative pain control and relief following elective short stay open paediatric inguinal hernia repair at KNH. Objective: To evaluate the effectiveness of post-operative pain management following elective short stay open inguinal hernia repair in children at KNH. Study design: Descriptive prospective study Study population: The study included 91children aged 3 months to 12 years with unilateral inguinal hernias admitted for open elective short stay surgery at the paediatric surgical unit of Kenyatta National Hospital between November 2014 and April 2015. Selection was by consecutive sampling until the desired sample size was achieved. Methodology: Details on type of inguinal hernia, analgesic medications prescribed, and whether dosage given was adequate for weight for children who underwent elective short stay open inguinal hernia repair was recorded. Pain was assessed, using age appropriate scales, on return to the ward after surgery and on the morning of discharge from hospital. The parents were then interviewed by telephone regarding their child‟s post-operative pain management at home. The interview 2 comprised the parents‟ assessment of the child‟s pain using the Parents Postoperative Pain Measure and an assessment of compliance to prescribed analgesics at home. Data was collected using pre-tested questionnaires, and then entered into an access database. Data analysis was done using SPSS version 22. Results The 91 children had a mean age of 3.3 years, with a male to female ratio of 5:1. The most commonly administered group of analgesics intra-operatively was paracetamol and local or regional anaesthetics, which were given to 62 children (68.1%). Intra-operative analgesics were given in the correct dose in 93% of the patients. On arrival to the ward, 74 children (81.4%) reported pain (mild, moderate, or severe). On the morning of the first post-operative day, before discharge, 50 children (55.1%) reported pain. The pain before discharge, from the ward, was not associated with type of post-operative analgesic administered. However there was an association with type of hernia, pulse rate and age of the patient. Twenty nine parents (31.9%) reported „significant‟ pain experienced by their children 48 hours after discharge during a telephone interview. Twenty two children (24.2%) were not discharged on any analgesics. Only 40% of patients reported to have received instructions on administration of analgesics at home, from a health worker in the ward, before discharge. Paracetamol was the most prescribed discharge analgesic at 48.4% and it was given in the correct frequency on the two days post-discharge, by only 45% of the parents interviewed. Conclusion: The current post-operative analgesia practices for elective short stay paediatric inguinal hernia repair are inadequate at the Kenyatta National Hospital. Improvement in post-operative pain management requires interventions to mitigate current barriers to effective post-operative pain management.