Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists.
anesthetist
pain assessment
pain management
pediatric
sub-Saharan Africa
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
11 Dec 2023
11 Dec 2023
Historique:
revised:
20
11
2023
received:
21
08
2023
accepted:
26
11
2023
medline:
11
12
2023
pubmed:
11
12
2023
entrez:
11
12
2023
Statut:
aheadofprint
Résumé
Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries. A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices. One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting. This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.
Sections du résumé
BACKGROUND
BACKGROUND
Children in hospital experience significant pain, either inherent with their pathology, or caused by diagnostic/therapeutic procedures. Little is known about pediatric pain practices in sub-Saharan Africa. This survey aimed to gain insight into current pain management practices among specialist physician anesthetists in four sub-Saharan African countries.
METHODS
METHODS
A survey was sent to 365 specialist physician anesthetists in Nigeria, South Africa, Uganda and Zambia. Content analysis included descriptive information about the respondents and their work environment. Thematic analysis considered resources available for pediatric pain management, personal and institutional pain practices.
RESULTS
RESULTS
One hundred and sixty-six responses were received (response rate 45.5%), with data from 141 analyzed; Nigeria (27), South Africa (52), Uganda (41) and Zambia (21). Most respondents (71.83%) worked at tertiary/national referral hospitals. The majority of respondents (130/141, 91.55%) had received teaching in pediatric pain management. Good availability was reported for simple analgesia, opioids, ketamine, and local anesthetics. Just over half always/often had access to nurses trained in pediatric care, and infusion pumps for continuous drug delivery. Catheters for regional anesthesia techniques and for patient-controlled analgesia were largely unavailable. Two thirds (94/141, 66.67%) did not have an institutional pediatric pain management guideline, but good pharmacological pain management practices were reported, in line with World Health Organization recommendations. Eighty-eight respondents (62.41%) indicated that they felt appropriate pain control in children was always/often achieved in their setting.
CONCLUSION
CONCLUSIONS
This survey provides insight into pediatric pain practices in these four countries. Good availability of a variety of analgesics, positive pain prescription practices, and utilization of some non-pharmacological pain management strategies are encouraging, and suggest that achieving good pain control despite limited resources is attainable. Areas for improvement include the development of institutional guidelines, routine utilization of pain assessment tools, and access to regional anesthesia and other advanced pain management techniques.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Jan Pretorius Research Fund
Organisme : South African Society of Anaesthesiologists
Informations de copyright
© 2023 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.
Références
Matula ST, Polomano RC, Irving SY. The state of the science in paediatric pain management practices in low-middle income countries: an integrative review. Int J Nurs Pract. 2018;24(6):e12695.
Kusi Amponsah A, Kyei EF, Agyemang JB, et al. Nursing-related barriers to Children's pain management at selected hospitals in Ghana: A descriptive qualitative study. Pain Res Manag. 2020;7125060. doi:10.1155/2020/7125060
Eccleston C, Fisher E, Howard RF, et al. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. Lancet Child Adolesc Health. 2021;5(1):47-87.
Albertyn R, Rode H, Millar AJ, Thomas J. Challenges associated with paediatric pain management in sub Saharan Africa. Int J Surg. 2009;7(2):91-93.
Muhly WT, Taylor E, Razavi C, et al. A systematic review of outcomes reported in pediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group. Pediatr Anesth. 2020;30(11):1166-1182.
Isaac N. Smile train launches pan-African pediatric anesthesia training. Science Nigeria. 2023; https://sciencenigeria.com/smile-train-launches-pan-african-pediatric-anesthesia-training/
Gai N, Naser B, Hanley J, Peliowski A, Hayes J, Aoyama K. A practical guide to acute pain management in children. J Anesth. 2020;34(3):421-433.
Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic review of pain medicine content, teaching, and assessment in medical school curricula internationally. Pain Ther. 2018;7(2):139-161.
Panteli D, Legido-Quigley H, Reichebner C, Ollenschläger G, Schaefer C, Busse R. Clinical practice guidelines as a quality strategy. In: Busse R, Klazinga N, Panteli D, Quentin W, eds. Improving Healthcare Quality in Europe: Characteristics, effectiveness and implementation of different strategies. WHO Regional Office Europe; 2019:233-264.
Wall SL, Clarke DL, Nauhaus H, Allorto NL. Barriers to adequate analgesia in paediatric burns patients. S Afr Med J. 2020;110(10):1032-1035.
Tujo TM, Gurmu TG. Availability and Utilization of WHO Lifesaving Medicines for Children under Five in Public Health Facilities of the Jimma Zone: A Cross-Sectional Survey. Int J Pediatr. 2020;3505672. doi:10.1155/2020/3505672
Simonini A, Brogi E, Cascella M, Vittori A. Advantages of ketamine in pediatric anesthesia. Open Med. 2022;17(1):1134-1147.
Oshikoya K, Ogunyinka I, Godman B. Off-label use of pentazocine and the associated adverse events among pediatric surgical patients in a tertiary hospital in northern Nigeria: a retrospective chart review. Curr Med Res Opin. 2019;35:1-1512. doi:10.1080/03007995.2019.1591109
Osifo OD, Aghahowa SE. Hazards of pentazocine for neonatal analgesia: a single Centre experience over 10 years. Ann Trop Paediatr. 2008;28(3):205-210.
Kuehn BM. FDA: No codeine after tonsillectomy for children. JAMA. 2013;309(11):1100. doi:10.1001/jama.2013.2403
Lundblad M, Trifa M, Kaabachi O, et al. Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children: a meta-analysis. Paediatr Anaesth. 2016;26(3):232-238.
Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015;115(2):171-182.
Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H, Zimmermann C. The lancet commission on palliative care and pain relief 2014 - findings, recommendations, and future directions. Lancet Glob Health. 2018;6:S5-S6.
James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. The Lancet. 2018;392(10159):1789-1858.
Motamed C. Clinical update on patient-controlled analgesia for acute postoperative pain. Pharmacy (Basel). 2022;10(1):22. doi:10.3390/pharmacy10010022
Splinter W. Novel approaches for treating pain in children. Curr Oncol Rep. 2019;21(2):11. doi:10.1007/s11912-019-0766-6
Li BL, Zhang N, Huang JX, et al. A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by drops. Anaesthesia. 2016;71:522-528. doi:10.1111/anae.13407
Xie Z, Shen W, Lin J, Xiao L, Liao M, Gan X. Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulation. Am J Emerg Med. 2017;35(8):1126-1130.
Hauer J, Houtrow AJ, Section on Hospice and Palliative Medicine, Council on Children with Disabilities. Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics. 2017;139(6):e2017-1002. doi:10.1542/peds.2017-1002
Pillai Riddell RR, Racine NM, Turcotte K, et al. Cochrane review: non-pharmacological management of infant and young child procedural pain. Evidence-Based Child Health: A Cochrane Review Journal. 2012;7(6):1905-2121.
Farzan R, Parvizi A, Haddadi S, et al. Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis. Int Wound J. 2023;20(7):2898-2913.
Kyololo OM, Stevens BJ, Songok J. Mothers' perceptions about pain in hospitalized newborn infants in Kenya. J Pediatr Nurs. 2019;47:51-57. doi:10.1016/j.pedn.2019.04.015