Background & Aims
Perioperative pain management is a crucial determinant of patient outcomes and satisfaction, posing unique challenges in middle-income countries like South Africa. This study, utilizing the international PAIN OUT registry, sought to evaluate the state of perioperative pain management across 10 hospitals. Baseline assessments conducted in 2022 in 1669 patients, undergoing a range of surgical procedures, identified deficiencies in pain assessment, inconsistent practice in the use of multimodal analgesia and poor delivery of information on pain management options to patients (1). These deficiencies were targeted with a ‘bundle’ of care successfully implemented in another resource poor country(2). The bundle includes 4 elements: preoperative patient education, use of local/regional anesthetic technique, full daily dose of non-opioid analgesics and routine postoperative pain assessment. We will report on the effect of the bundle on patient outcomes based on data currently being collected.
Methods
The PAIN OUT, international perioperative pain registry, offers tools for assessing patient reported outcomes and pain management on the first postoperative day. Assessment included whether patients received four evidence-based pain management techniques, largely independent of surgery and recommended for most patients undergoing surgery as part of a multimodal treatment approach. The baseline phase spanned eleven months, during which perioperative pain management practices were assessed. Subsequently, the four-part bundle intervention was introduced, and its impact was measured over the following six months.
Results
Baseline assessments revealed ?50% (median) of patients reported experiencing severe pain; pain interfered with activities in bed in 42,6% and interfered with sleep in 36,4% of patients. 37,2% reported helplessness due to pain; ?50% would have liked to receive more pain treatment. A full daily dose of 1-2 non-opioid analgesics was administered to 32% of patients; 82% of patients received at least one local/regional anesthesia technique; pain was assessed in 10% of patients; receiving information about pain management options was reported by 27%. We are currently collecting data to evaluate the same outcomes following the implementation of the four-part bundle intervention.
Conclusions
This study will report on the outcome of implementing a four-part bundle intervention in addressing the challenges of perioperative pain management in South Africa. The intervention’s multifaceted nature, encompassing standardized protocols, multidisciplinary collaboration, education, and improved communication, aims to significantly improve postoperative pain outcomes.
References
1.Chetty S, Baumbach P, Sankar K, Pretorius T, Saw M, Mafanya C, et al. Working towards improving perioperative pain management in South Africa: analysis of data collected at baseline. Pain in Europe XIII; 20-22 September 2023; Budapest: EFIC; 2023. p. 81-2.
2.Stamenkovic D, Baumbach P, Radovanovic D, Novovic M, Ladjevic N, Dubljanin Raspopovic E, et al. The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry. Clin J Pain. 2023;39(10):537-45.
Presenting Author
Sean Chetty
Poster Authors
Romy Parker
PhD
University of Cape Town
Lead Author
Sean Chetty MBChB(Natal)
DCH(SA)
Dept of Anaesthesia and Critical Care, Stellenbosch University
Lead Author
Philipp Baumbach
PhD
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Christin Arnold
PhD
Jena University Hospital
Lead Author
Sudha Bechan MBChB DA FCA Cert Crit Care MSc Pain(
Inkosi Albert Luthuli Central Hospital
Lead Author
Nana Biyase
University of the Witwatersrand and Charlotte Maxeke Hospital
Lead Author
Alma De Vaal MBchB
DA
Groote Schuur Hospital and University of Cape Town
Lead Author
Sherif Isa BSc
MSc
Department of Human Physiology, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, K
Lead Author
Marcus Komann
Dr.-Ing
Jena University Hospital
Lead Author
Cikizwa Mafanya BSc(Phys) MSc(Phys)
Netcare Alberton hospital
Lead Author
Anuel Mallier Peter MBBS,DA,DNB(Anesthesia)
Klerksdorp/ Tshepong Hospital Klerksdorp, Northwest
Lead Author
Winfried Meissner
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Claire Pfister MBBCh (Wits) FCA(SA)
Groote Schuur Hospital and University of Cape Town
Lead Author
Tania Pretorius MB,ChB ; FCA (SA); MMed Anaesth
Paarl Provincial Hospital
Lead Author
Jessica Purcell-Jones MBBS BSc FCA
Groote Schuur (employed)/ New Somerset hospital (PI)
Lead Author
Keenan Sankar MBChB (Stell)
FCA (SA)
Stellenbosch University Dept of Anaesthesiology and Critical Care
Lead Author
Melissa Saw
MSc and BSc Physiotherapy
Mediclinic Panorama
Lead Author
Claudia Weinmann
MSc
Jena University Hospital
Lead Author
Ruth Zaslanky
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Adele Myburgh MBChB
DA
Chris Hani Baragwanath Academic Hospital
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain