Postoperative pain management in children: A survey of practices of pediatric surgeons in Nigeria

Abstract

Background: Postoperative pain has a negative effect on the process of recovery. There is paucity of literature on the postoperative pain management practice in children in developing countries. We sought to determine the current practice of postoperative pain management in children among pediatric surgeons in Nigeria. Methods: A cohort of 43 pediatric surgeons/trainees attending two annual meetings of Association of Paediatric Surgeons of Nigeria (2011 and 2013) were surveyed with a questionnaire enquiring about the practice of postoperative pain management in children and their perceptions. Results: Thirty-seven respondents had completed the survey (86% response rate). Of these respondents, 27 (73.0%) were consultants and 10 (27.0%) were trainees. Only 2 (5.4%) respondents used any guidelines, and 8 (21.6%) respondents had an established institutional protocol for the pediatric postoperative pain management. Almost half of the respondents (18, 48.6%) used clinical judgments for assessing postoperative pain, followed by crying, requires oxygen to maintain saturation > 95%, increased vital signs, expressions, and sleeplessness scale (13, 35.1%); alertness, calmness, respiratory response/crying, physical movement, muscle tone, and facial tension behavioral scale (11, 29.7%); and verbal rating (10, 27.0%). In neonates, 89% of the respondents used paracetamol and 32% used pentazocine for routine postoperative analgesia. None of the respondents used morphine for neonatal postoperative analgesia. In older children, commonly used analgesics include paracetamol (35, 94.6%), pentazocine (30, 81.1%), and nonsteroidal anti-inflammatory drugs (28, 75.7%). More than half of the respondents (20, 54.1%) were not satisfied with their current practice of postoperative pain management. Conclusion: Pain was infrequently assessed, and analgesic therapy though multimodal was largely not protocol based and therefore subject to inadequate pain relief. Postoperative pain should be more visible in our hospitals, and efforts should be made to improve its assessment and management.