Appropriateness of postoperative analgesic doses among pediatric surgical patients in a teaching hospital in Northwest Nigeria

Abstract

The inappropriate and suboptimal use of analgesic drugs is a global problem, and is an area of concern with regard to the management of postoperative pain, particularly in children. Information relating to the management of postoperative pain in children is generally limited, particularly in low- and middle-income countries, and is unavailable in Northwest Nigeria. The aim of this study was to describe the types of analgesics used postoperatively in children, evaluate the appropriateness of their doses compared with best practice, and determine risk factors for underdosing of analgesics. We performed a retrospective chart review of patients administered analgesics after surgery between 1 January 2015 and 31 December 2017. The appropriateness of the analgesic doses was categorized as underdose, normal dose, or overdose. Simple descriptive and comparative statistical analyses were performed. Logistic regression was used to build an analgesic underdose risk-prediction model. Overall, 194 patients received a total of 281 prescriptions for seven different analgesics, with 112 (57.7%), 77 (39.7%), and 5 (2.6%) patients receiving one, two, and three analgesics, respectively. Of the 281 analgesic prescriptions, paracetamol accounted for 148 (52.7%) and pentazocine accounted for 77 (27.4%), and there were 64 cases of overdosing (22.8%) and 89 of underdosing (31.7%). There was a statistically significant association between analgesic type and category of dose appropriateness (p < 0.001). The risk of underdosing was not predicted by any of the patient demographic characteristics or by the number of analgesics used. Inappropriate use of analgesics (overdosing or underdosing) is common and is found across all analgesic types and all age groups. A substantial number of children were underdosed, suggesting undertreatment of pain.