Severity and Associated Factors of Postoperative Pain in Pediatric Surgical Patients Aged two Months to Seven Years at Selected Addis Ababa Public Hospitals, Ethiopia 23: Longitudinal Study
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Date
2023-06-19
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Addis Ababa University
Abstract
Post operative pain is a body response to the actual surgical tissue damage that results suffering, prolonged recovery, decreased mental and physical functioning and development of chronic pain. Appropriate postoperative pain assessment and management in pediatric patients reduce pain suffering and increases comfort. However, several perioperative, professional and other factors hinder to estimate the severity and its management mainly in lower income countries.
Objectives: To assess the severity and predictors of postoperative pain in pediatric surgical patients aged 2 months to seven years at selected Addis Ababa Public Hospitals, Ethiopia 2023.
Methods: A prospective longitudinal study was conducted on a cohort of 235 pediatric surgical patients aged 2 months to 7 years at selected Public Hospitals in Addis Ababa from January 2023 to April 2023.The exposure and other variables were acquired by questionnaire, direct observation, and questions posed to service providers. The primary outcome, pain severity, was assessed at 12, 24, and 36 hours postoperatively using a validated pain assessment tool tailored to this age group. Cochran's q test was used to see the difference in the incidence of postoperative pain between each time measurements. Generalized Estimating Equation was used to determine the predictor variables effect on pain severity over time. The direction of association and its significance were demonstrated by an adjusted odds ratio with a 95% confidence interval at a cut off p value of 0.05.
Result: The incidence of moderate to severe postoperative pain in this study is 36.6%, 20% and 10% at 12, 24 and 36 hours respectively. Patients with preoperative pain and preoperative anxiety increases the odds of postoperative pain severity (AOR=3.41, CI=1.15,10.00 and AOR=2.28, CI=1.219,4.277 respectively). Longer duration of surgery and being major surgery were the main predictors of post operative pain level from intraoperative predictors (AOR=6.62, CI=1.90,23.00; AOR=5.2, CI=2.11,12.88 respectively). Patients receiving multimodal analgesia and patients assessed frequently in the postoperative period has significantly reduced postoperative pain level (AOR=0.24; CI=0.091, 0.652; AOR=0.09; CI= 0.022, 0.393 respectively).
Conclusion: Many Pediatric surgical patients in the studied Hospitals have high postoperative pain level, mainly in the first 24 hour, that require treatment. Among other factors, the most
modifiable predictors that affect postoperative pain severity in these population are postoperative pain management and assessment practices.
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Keywords
Pediatrics, Pediatric Surgery, Postoperative pain, Severity