Background & Aims

Perioperative pain management stands as a critical facet of healthcare, impacting patient outcomes and satisfaction. In middle-income countries like South Africa, challenges in delivering optimal care prompt the need for innovative strategies. Following the successful implementation of a bundle of care to improve postoperative pain outcomes in Serbia (1), this is the second attempt to implement a bundle in a middle-income country. This project explores the feasibility of implementing a bundled approach to perioperative pain management in ten hospitals. The central aim is to assess the fidelity to the bundle, examining the adherence to evidence-based guidelines, multidisciplinary collaboration, education, and standardized protocols in the unique context of a middle-income country.

Methods

The international PAIN OUT registry serves as a tool for assessment of perioperative pain management practices. Data were entered into the registry from ten participating hospitals over three months including 1669 patients. Subsequently, a four-part bundle intervention was introduced, with the four elements of the bundle being (i) Ensuring every patient receives information about pain and how to manage it; (ii) Optimizing non-opioid pain management by standardizing prescribing; (iii) Optimizing intraoperative analgesia with at least one local/regional anesthetic technique used and (iv) Optimizing postoperative care with nurse education and training in routine assessment and management of pain. Data collection is currently underway another three months post-intervention, to evaluate the extent to which the bundle elements are faithfully adopted in these diverse healthcare settings.

Results

Baseline findings indicated significant variability in perioperative pain management practices, with common challenges such as inadequate pain assessment and inconsistent protocols. We hope that the introduction of the bundle intervention will result in marked improvements. We will report on the fidelity to delivery of the bundle elements and evaluate facilitators and barriers to implementation.

Conclusions

This project will demonstrate the feasibility of implementing a quality improvement project using the PAIN OUT registry in South Africa’s middle-income healthcare setting. The fidelity to the bundle, and barriers and facilitators to implementation will be elucidated. The interim data suggest improvements in postoperative pain outcomes emphasizing the positive impact of the bundle on patient care. This study contributes valuable insights to the global discourse on perioperative pain management, highlighting the feasibility and effectiveness of bundled interventions in middle-income countries.

References

1. 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

Romy Parker

Poster Authors

Romy Parker

PhD

University of Cape Town

Lead Author

E-mail

Ruth Zaslanky

Jena University Hospital, Friedrich Schiller University, Jena, Germany

Lead Author

E-mail

Christin Arnold

PhD

Jena University Hospital

Lead Author

E-mail

Sudha Bechan MBChB DA FCA Cert Crit Care MSc Pain(

Inkosi Albert Luthuli Central Hospital

Lead Author

E-mail

Nana Biyase

University of the Witwatersrand and Charlotte Maxeke Hospital

Lead Author

E-mail

Alma De Vaal MBchB

DA

Groote Schuur Hospital and University of Cape Town

Lead Author

E-mail

Sherif Isa BSc

MSc

Department of Human Physiology, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, K

Lead Author

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Marcus Komann

Dr.-Ing

Jena University Hospital

Lead Author

E-mail

Cikizwa Mafanya BSc(Phys) MSc(Phys)

Netcare Alberton hospital

Lead Author

E-mail

Anuel Mallier Peter MBBS,DA,DNB(Anesthesia)

Klerksdorp/ Tshepong Hospital Klerksdorp, Northwest

Lead Author

E-mail

Winfried Meissner

Jena University Hospital, Friedrich Schiller University, Jena, Germany

Lead Author

E-mail

Claire Pfister MBBCh (Wits) FCA(SA)

Groote Schuur Hospital and University of Cape Town

Lead Author

E-mail

Tania Pretorius MB,ChB ; FCA (SA); MMed Anaesth

Paarl Provincial Hospital

Lead Author

E-mail

Jessica Purcell-Jones MBBS BSc FCA

Groote Schuur (employed)/ New Somerset hospital (PI)

Lead Author

E-mail

Keenan Sankar MBChB (Stell)

FCA (SA)

Stellenbosch University Dept of Anaesthesiology and Critical Care

Lead Author

E-mail

Melissa Saw

MSc and BSc Physiotherapy

Mediclinic Panorama

Lead Author

E-mail

Claudia Weinmann

MSc

Jena University Hospital

Lead Author

E-mail

Philipp Baumbach

PhD

Jena University Hospital, Friedrich Schiller University, Jena, Germany

Lead Author

E-mail

Sean Chetty MBChB(Natal)

DCH(SA)

Dept of Anaesthesia and Critical Care, Stellenbosch University

Lead Author

E-mail

Adele Myburgh MBChB

DA

Chris Hani Baragwanath Academic Hospital

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain