A crosssectional study of factors contributing to moderate to severe post operative pain after a laparotomy

Abstract

Having pain relief is a basic human right. This thesis provides a descriptive profile of pain before and during the first 72 hrs after a laparotomy at University Teaching Hospital, Lusaka, Zambia, from July 2014 to January, 2015. The objective was to identify independent risk factors associated with moderate to severe pain after laparotomy. To determine the incidence of moderate (FPS 5-6) and severe (FPS 7-10) postoperative pain in patients within 72 hrs of laparotomy. To identify factors associated with moderate to severe post-operative pain. Both elective and emergency cases where included. Cases where enrolled through convenience sampling from The Gynecology, General surgery and Urology theaters and then followed up in their respective post-operative wards at the University Teaching Hospital, Lusaka, Zambia. It was found that age, sex, weight, residential location, grade of anaesthetist and surgeon and type of procedure did not contribute significantly to moderate to severe pain. Most patients experienced moderate to severe pain in the pre-operative phase and some degree of pain in the immediate post-operative period. Overall 31.2 % of the patients had moderate to severe pain in the immediate post-operative period. The incidence of moderate to severe pain at 24 hrs and 48 hrs post operatively was 39.3 % and 39.1 %respectively. This pain reduced to 26.5 % at 72 hrs. Patients who had received Ketamine or Morphine and Ketamine combinations had relief in the immediate 2 hrs post-operative phase. Patients who had a spinal anaesthesia where 2.5 times more likely to experience moderate to severe pain in the immediate post-operative period. The study revealed that pre-operative is a major area of concern and adequate pain management is lacking in this area. It was established that there was an incidence of moderate to severe pain though lower than what was reported in literature previously and it remains a significant problem following a laparotomy in our environment. I established that moderate to severe pain remains a significant problem following a laparotomy in our environment. Simple easily accessible drug like ketamine or a combination of ketamine and morphine given intra operatively will provide adequate analgesia for up to 6 hrs post operatively. Patients who received spinal anaesthesia and had transverse incision had moderate to severe pain in the first 6 hours post op. A midline incision was more painful than transverse at 24 hrs, 48 hrs and 72 hrs post-operative period. Other contributing factors to post-operative pain in Laparotomy patients at University Teaching Hospital in Lusaka which were not in the scope of this study but could be explored is shortages of nurses; inadequate to lack of tools for assessing pain; and random drug regimens.