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