Management Practices of Postoperative Pain in Neonates at Newborn Unit, Moi Teaching and Referral Hospital, Kenya

Abstract

Abstract Introduction: Neonates undergoing surgeries in hospitals worldwide undergo average to severe postoperative pain. Surmounting evidence demonstrates that, controlling pain in the neonatal period is beneficial in improving physiologic, behavioral, and hormonal outcomes. However, there is paucity of information by the health care providers regarding knowledge and skills on postoperative neonatal pain management. Objective: The objective of the study was to describe management of postoperative pain among neonates at the new born unit in Moi Teaching and Referral hospital (MTRH), Kenya. Methodology: The study design was a prospective descriptive study conducted at the newborn unit, MTRH. Data collection tools and procedures used were check list for observation of pain management practices and health care provider questionnaire to interview nurses and pediatric doctors in regard to management of postoperative pain in neonates in order to augment observation data. Data analysis consisted of descriptive (mean, median and standard deviation) and inferential (logistic regression and correlation) statistical procedures. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.0 program and presented in tables, graphs, frequencies and content analysis. Results: Data from 68 neonates and 45 health care providers were collected for this study on the basis of inclusion and exclusion criteria. Enrolled neonates had a birth weight of 2.6 ± 0.74 kg (mean ± SD; range: 1.3 – 4.7 kg); gestational age at birth of 38 ± .14 weeks (range: 34 –40 weeks), age in days at surgery of 6 ± 8.5 weeks (range: 1–40 days), Heart rate on admission was 149 ±4.6 (range: 138 –162 beats per minute); and Oxygen saturation in percentage was 99 ± 1.1 percentage (range: 96-100 percentag e). Most neonates (91.2% [n = 68]) underwent major surgery, where by 30.9 % had anorectal malformation [n=68].Majority of the neonates 65 (95.6%) experienced severe pain at the 9th hour postoperatively. Tramadol was the main analgesic used. Tactile soothing and talking to the postoperative neonates were the main nonpharmacological methods used. Conclusion: From the study, there was no standardized postoperative neonatal pain assessment scale in place in the new born unit at Moi Teaching and Referral Hospitalleading to subjective management of neonatal postoperative pain. In addition, Tramadol was found to be the drug of choice used in managing neonatal pain. The nonpharmacological methods used were tactile soothing and talking to the neonates. Further, there were no objective tools and management guidelines to assess neonatal pain at the newborn unit which resulted to irregular neonatal postoperative pain management. Recommendation: Evidence-based guidelines for postoperative care are needed for all providers of neonatal care in this unit. In addition, there is need for continuing professional education for all professional staff on the systematic assessment and management of postoperative pain in neonates. Key words: , , postoperative pain. -------------------------------------------------------------------------------