Knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at UNIOSUN Teaching Hospital (UTH), Osogbo, Osun State

Labour pain is perceived as the most harrowing and agonizing event of a woman's life. Efforts at reducing the pain and making the event less stressful have predated modern obstetric practice. Epidural analgesia has provided effective pain relief in labour for over three decades. Delivery with epidural analgesia is routine for willing parturients in the developing world, however ignorance, cost as well as lack of qualified personnel has made this to be out of reach of the average Nigerian mother. The aim of this study was to assess level of awareness, acceptability, previous utilization and willingness to utilize epidural analgesia in labour following health education.Subjects/Methods: This cross-sectional study was carried out in the antenatal clinic of UTH, Osogbo. Health education on events of labour and methods of analgesia available was provided to all antenatal clinic attendees between September 2021and March 2022, following which a semi­structured purpose designed, and self- administered questionnaire was administered to 415 of these women who consented to participate in this study. Results: The mean age of the respondents was 32.57± 4.42 years and mean parity of 1.73± 0.96. 70.8% reported that labour pain was severe. 41.7% were aware of epidural analgesia before the health talk. 3.6% of our subjects had utilized epidural in their last confinement. However, only 47.7% expressed a wish to utilize epidural analgesia in labour. Conclusion: Awareness of epidural analgesia in study population was passable at 40% however willingness to utilize it was less than average despite health talk and reassurance by their attending obstetric team.

Aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du District de la Commune IV de Bamako (Mali) / Clinical aspects of internal haemorrhoidal disease in the district hospital of Council IV of Bamako (Mali)

Introduction. La maladie hémorroïdaire interne est la plus fréquente des affections proctologiques et constitue un motif extrêmement répandu de consultation en proctologie. L'objectif de ce travail était de décrire les aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako. Patients et méthodes. Nous avons réalisé une étude transversale descriptive sur un groupe de malades vus en consultation à l'unité de Gastro-entérologie de l'hôpital du district de la commune IV de Bamako. Entre le 1er Novembre 2019 et le 31 Octobre 2020, le recrutement des patients a été réalisé. Les variables recueillies étaient les données sociodémographiques (âge, sexe, profession), les symptômes anaux (saignement anal, douleur anale, suintements muco-glaireux, prurit anal), les facteurs de risque (les troubles du transit intestinal, la période du troisième trimestre de la grossesse, l'accouchement, le post-partum immédiat), les stades de la maladie hémorroïdaire interne, les autres pathologies anales associées, les complications, l'hémogramme. Résultats. Durant la période d'étude, 128 patients ont été vus en consultation parmi lesquels 85 avaient une maladie hémorroïdaire interne, soit une fréquence de 66,40%. La procidence hémorroïdaire a été observée chez 18,8% de nos patients. En fonction de son degré, le grade I représentait 34,1%, le grade II 55,3%, le grade III 9,4% et le grade IV 1,2%. Conclusion. Cette première étude réalisée sur la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako montre que la maladie hémorroïdaire interne est l'affection proctologique la plus fréquente.

Introduction. Internal haemorrhoidal disease is the most common proctological condition and is an extremely common reason of consultation in proctology. The objective of this work was to describe the clinical aspects of internal haemorrhoidal disease in the district hospital of the commune IV of Bamako. Patients and methods. We conducted a descriptive cross-sectional study on a cohort of patients seen in consultation at the Gastroenterology Unit of the District Hospital of Bamako's commune IV. The recruitment was carried out between November 1, 2019 and October 31, 2020. The variables of study were socio-demographic data (age, sex, profession), anal symptoms (anal bleeding, anal pain, muco-glue oozing, anal pruritus), risk factors (intestinal transit disorders, third trimester of pregnancy, childbirth, immediate postpartum), stages of internal haemorrhoidal disease, other associated anal pathologies, complications, blood count. Results. During the study period, 128 patients were seen in consultation, among whom 85 had internal haemorrhoidal disease (66.40%). Hemorrhoidal procidence was found in 18.8% of patients. Concerning the severity, grade I represented 34.1%, grade II 55.3%, grade III 9.4% and grade IV 1.2%. Conclusion. This pioneer study on internal haemorrhoidal disease in the district hospital of commune IV of Bamako (Mali) showed that internal hemorrhoidal disease is the most common proctological condition in Bamako.

Perception douloureuse et moyens de lutte en hystéroscopie au cabinet / Pain perception and management during office hysteroscopy

Contexte & objectif. L'hystéroscopie a connu des avancées majeures ces dernières à différents points de vue. Elle est passée d'une procédure nécessitant une hospitalisation à une procédure ambulatoire, de même elle a quitté la salle d'opération pour rejoindre le cabinet de consultation. Mais, un des problèmes à ces progrès, c'est la gestion de la douleur au cours et après la procédure. La présente revue passe en revue les différents moyens, tant pharmacologiques que non pharmacologiques utilisés pour la réduction de la perception de la douleur au cours d'une hystéroscopie au cabinet. Méthodes. Il s'agissait d'une revue exhaustive de la littérature (Pubmed, Medline, cochrane library) concernant les méta-analyses, revues de la littérature et essais randomisés publiés sur le sujet et en anglais de 2003 à 2021. Conclusion. Plusieurs moyens avec une efficacité très variable sont proposés pour réduire la douleur au cours de l'hystéroscopie au cabinet. Les auteurs s'accordent sur le fait que la bonne maitrise de l'anatomie de la filière génitale féminine vue en hystéroscopie, l'approche vaginoscopique et la psychothérapie permettent de diminuer significativement la douleur au cours de l'hystéroscopie et donc d'en améliorer la tolérance sans nécessité une quelconque anesthésie ou analgésie

Disability and functioning in primary and secondary hip osteoarthritis in Benin

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis. Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis. Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou. Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a t-test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status. Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification. Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life

An overview of analgesics: NSAIDs, paracetamol, and topical analgesics

Pain is a complex and unique experience. It encompasses several pathways, involving nociceptive signal generation (transduction) and propagation (transmission), as well as perception and modulation of the nociceptive stimuli. Nonsteroidal anti-inflammatory drugs (NSAIDs) primarily exert their analgesic effects through inhibition of cyclooxygenase (COX) enzymes, thereby attenuating prostaglandin synthesis. The COX-2 selective NSAIDs (coxibs) and aspirin have also been shown to reduce colorectal cancers,presumably by prostaglandin-inhibition mechanisms. Paracetamol appears to have both peripheral and central effects. The postulated mechanism for its peripheral effects is indirect COX inhibition, while the central effects are thought to be mediated by modulation of descending pain inhibition pathways. Topical analgesics are available in various formulations. The topical NSAIDs have the same mechanism of action as the systemic formulations, but with less systemic absorption and effects. The local anaesthetics provide a dense sensory block via inhibition of nerve impulse transmission, and are available in percutaneous and transdermal preparations. Capsicum is effective forneuropathic pain, and acts by stimulating and then desensitising peripheral sensory nerves

Evaluation de la qualité de la prise en charge de la douleur chez les patients en milieu hospitalier à Cotonou

Objectifs : La douleur est l'un des motifs les plus fréquents de demande de soins. L'objectif de notre étude était d'évaluer la qualité de sa prise en charge chez les patients adultes hospitalisés au CNHUHKM de Cotonou. Méthodes d'etude : Il s'agissait d'une étude transversale, descriptive conduite sur une période de 09 mois allant de Janvier à Septembre 2016 au CNHU-HKM. Un recrutement exhaustif a été fait pendant la période d'étude et a inclus les sujets adultes hospitalisés depuis au moins 24 heures. L'APS-POQR (American Pain Society- Patient Outcome Questionnaire- Revised) a été modifié et intégré dans l'outil de collecte des données. Résultats : Des 408 patients recrutés, 76,7% avaient ressenti une douleur au cours des 24 premières heures d'hospitalisation. La douleur était sévère chez 72,5% de ces patients. On notait une prédominance masculine et une fréquence de la douleur plus importante en chirurgie. En dépit de la forte prévalence et de la sévérité de la douleur, près de 2 sur 3 patients (70,1%) d'entre eux étaient au moins modérément satisfaits du traitement antalgique. Conclusion : La douleur est fréquente, sévère et sous traitée au CNHU-HKM. L'étude suggère l'instauration d'une véritable « culture de lutte contre la douleur » qui commence dès la formation théorique des soignants dans les universités et qui continue dans les différents services à l'hôpital

Vitamin d status in children with acute lymphoblastic leukemia

Background: Skeletal morbidities are a common initial presentation and outcome in acute lymphoblastic leukemia(ALL). Vitamin D plays a vital role in the physiological regulation of calcium and phosphate transport and bone mineralization. Also high (25(OH)) level and high vitamin d intake at the time of diagnosis and initiation of anticancer treatment were associated with improved outcome. Methods: Twenty five ALL patients admitted to hematology and oncology unit, children hospital Zagazig University in one-year .vitamin D (25 (OH)) level was assessed in all patients at diagnosis. Patients were classified into deficient vitamin D (0-20)ng/ml , insufficient vitamin D (20-30)ng/ml and sufficient vitamin D (30-50)ng/ml. Statistical analysis was done to determine relation between different groups and ALL patients characteristics. Results: Vitamin D deficient in 24% of patients, vitamin D insufficient in 48% of patients, and vitamin D sufficient in 28% of patients. There was high statistical difference between different groups regarding bone pain and sex. Conclusions: A non-sufficient level in childhood all (deficiency and insufficiency) is common in childhood ALL and this is related to bone pain as initial clinical presentation. Vitamin D is related to presentation and prognosis of ALL in children

'Pain and stress are part of my profession': Using dental practitioners' views of occupation-related factors to inform dental training

Background. Stress is prevalent among dental workers and students. A possible means to address this would be to include stress management programmes in undergraduate dental programmes. The purpose of this study was to establish how the current cohort of dental practitioners incorporate occupational health and self-care principles into professional practice, and their potential relevance to future curriculum design.Objectives. To gain input from participants regarding stress and burnout ­ their causes, implications and prevention ­ as linked to their practice in dentistry.Methods. A qualitative research design was used, with a purposive sampling technique. The study population consisted of dentists, dental therapists, hygienists and specialists. A total of 36 participants participated in four focus-group discussions to explore dental education, occupational health, stress and self-care. The data were thematically analysed.Results. Dental training in the South African context, occupational health experiences, self-care, coping strategies and education were the main themes that emerged. Dental services in the public sector were reported to be overwhelmed by high patient volumes and shortages of staff and resources, which added to these stressors. The coping strategies adopted were exercise, stretching, reducing workload and encouraging teamwork. The participants believed that the causes of musculoskeletal disorders, and their impact, should be taught in dental training, as students do not perceive this as a potential problem. A multidisciplinary approach and teamwork training are the recommendations for curricula.Conclusion. Stress management techniques and workplace posture assessment should be taught in preclinical training to make students aware of managing stress and correct working postures. A multidisciplinary approach should be used. Dental curricula should include occupational health safety principles

Intravenous paracetamol ­ waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex­Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa. Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol. Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21­ 32.3 mg/kg). Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required

Development and validation of the isiZulu quality of recovery score

Background: Recovery from anaesthesia and surgery is an important marker of the quality of perioperative care. One extensively validated score in assessing this is the Quality of Recovery­15 items (QoR-15) score. This study aimed to translate the QoR-15 score into isiZulu and validate both the original and translated version on an isiZulu speaking population. Methodology: A randomised quantitative observational study was performed testing the original and the translated version of the QoR-15 score. In a crossover format, patients were asked to complete both questionnaires with 40 minutes allowed between each questionnaire. A 100 mm visual analogue score (VAS) was completed by each participant as a comparative tool for overall quality of recovery. Results: There was good correlation between the English and isiZulu score 0.91 (p < 0.001) and substantial agreement between the scores (mean weighted kappa: 0.69). There was a negative correlation between duration of surgery and total QoR-15 scores for both the English (­0.3; p < 0.001) and isiZulu (­0.29; p < 0.001) questionnaires, and a positive correlation between VAS scores and total QoR-15 scores for both the English (0.38; p < 0.001) and isiZulu (0.38; p < 0.001) questionnaires. Conclusion: This study demonstrates that the QoR-15 score is suitable to use in an isiZulu speaking patient population. The translated isiZulu version is comparable to the English QoR-15 score and should be used to assess the QoR to improve patient care

Xylocaine® 10% Pump Spray as topical anaesthetic for venepuncture pain

Background: Cutaneous analgesia for venepuncture pain can be achieved using various topically applied local anaesthetic formulations. Xylocaine® 10% Pump Spray containing lignocaine hydrochloride and 95% ethanol is exclusively recommended for mucosal anaesthesia. However, this formulation is readily able to penetrate skin. This study investigated whether topical pretreatment with Xylocaine® 10% Pump Spray could facilitate analgesia for venepuncture. Methods: A single-centre, prospective, randomised, double-blind placebo-controlled trial was conducted. One hundred patients were enrolled. The control and intervention groups had 0.5 ml saline and 0.5 ml Xylocaine® applied for 20 min to preselected venepuncture sites. Pain associated with an 18-gauge cannula venepuncture was rated on an 11-point Numerical Rating Scale. A two-point or 30% reduction in pain would be deemed clinically significant. Results: Pain scores were lower (p = 0.001) in the Xylocaine® (median 2; 95% CI 2­3) than the saline (median 4; 95% CI 3­5) group. Moderate-to-severe pain occurred in fewer Xylocaine® (18%) than saline (42%) treated patients (relative risk 0.43, CI 0.22 to 0.48; NNT = 5). Conclusion: Topical Xylocaine® 10% Pump Spray pre-treatment provided a time-effective method of reducing venepunctureassociated pain

Prise en charge de la douleur : Quel outil de mesure adopté pour une évaluation optimale

L'Organisation Mondiale de la santé recommande que chaque pays fasse de la politique de lutte contre la douleur cancéreuse une priorité dès 1986. Le choix de l'outil d'évaluation de la douleur à appliquer pour une estimation précise et objective de celle-ci est un problème auquel se heurtent les praticiens quotidiennement.La revue bibliographique menée sur les bases bibliographiques Pubmed, Scopus et Science Direct a permis de dresser un panel de questionnaires avec des spécificités d'utilisation et applicables à différents contextes cliniques et socio-culturels. Deux catégories de questionnaires ont été analysées. La 1ère catégorie comprend des questionnaires verbaux. Elle renferme entre autres les Mc Gill Pain Questionnaire, Brief Pain Inventory, European Organization Research and Treatment of Cancer et leurs variantes. Les deux premiers sont applicables à différents contextes cliniques. Le dernier groupe est adapté au contexte spécifique du cancer avec ses différents modules, cancer du sein, de la thyroïde ou autre cancer.La 2ème catégorie comprend des questionnaires basés sur l'approche iconique. Elle renferme entre autres Pictorrino, ODEON, Questionnaire de Tack et ses collaborateurs. Développé respectivement pour des pathologies spécifiques comme les pathologies Oto-Rhino-laryngiques, Ophtalmiques et gastriques.Les éléments critiques à considérer dans l'option pour un outil ou un autre sont, le contexte clinique d'utilisation ou la pathologie en cause et l'objectif ou la dimension ciblée par l'évaluation de la douleur ou l'inconfort

Grosses bourses douloureuses de l'enfant au centre hospitalier et universitaire de Brazzaville

But. Décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs des grosses bourses douloureuses dans notre pratique quotidienne. Matériels et méthodes. Il s'agit d'une étude transversale rétrospective a visée descriptive réalisée dans le service de chirurgie pédiatrique du Centre Hospitalier et Universitaire de Brazzaville, entre janvier 2012 et décembre 20014 soit 2 ans. Les dossiers de 43 enfants âgés de 0 à 15 ans hospitalisés pour une grosse bourse douloureuse et jugés exploitables ont été analysés. Les paramètres étudiés étaient : les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs. Résultats. 960 enfants ont été admis dans le service pendant la période d'étude. Parmi eux, 43 cas (4,5%) l'étaient pour une grosse bourse douloureuse. L'âge moyen des patients était de 2,5 ans avec des extrêmes de 0 et 15 ans. Le délai moyen de consultation était de 49 heures (extrêmes : 1-192 heures). La hernie inguino scrotale étranglée n= 23 (53,48%), la torsion du cordon spermatique n= 11 (25,58%), l'orchiépididymite n= 5 (11,62%), l'œdème aigu idiopathique du scrotum n=3 (7%), le traumatisme ouvert du scrotum n=1 (2,3%) étaient les principales étiologies. Le traitement a été chirurgical d'emblée pour la hernie inguino scrotale étranglée, la torsion du cordon spermatique et le traumatisme ouvert du scrotum et les suites opératoires ont été simples. Le traitement a été médical pour les orchiépididymites, les œdèmes aigues idiopathiques. Conclusion. À Brazzaville, les grosses bourses douloureuses de l'enfant constituent une urgence en chirurgie pédiatrique et comprennent une diversité d'étiologies susceptibles de compromettre le pronostic vital dont les plus fréquentes sont la hernie étranglée et la torsion du cordon spermatique

Evaluation de la prise en charge de la douleur du patient drépanocytaire à l'hôpital central de Yaoundé

But. La drépanocytose a pour maitre symptôme la douleur, laquelle nécessite une thérapeutique analgésiante dont la référence demeure la morphine. C'est un antalgique de troisième palier, classe thérapeutique peu utilisée sur le continent africain selon des études menées par l'OMS. Notre étude avait pour but de décrire la prise en charge de la douleur du patient drépanocytaire hospitalisé pour crises vaso-occlusives au service d'hémato-oncologie de l'Hôpital Central de Yaoundé. Méthodes. Nous avons mené une étude prospective, descriptive du 1er janvier au 30 juin 2014. Des drépanocytaires connus d'au moins 6 ans hospitalisés pour crise vaso-occlusive étaient recrutés. Les analgésiques utilisés et leur posologie étaient relevés pour chacun. La douleur avant et après l'administration des antalgiques était évaluée avec une Échelle Visuelle Analogique (EVA) ou une Échelle Numérique (EN) et la satisfaction du patient aux analgésiques reçus, notée. Résultats. Nous avons recruté 73 drépanocytaires homozygotes âgés de 7 à 53 ans et d'âge moyen égal à 23,04 ±8,35 ans pour un sex ratio de 1,21. Les antalgiques des paliers 1 et 2 ont été prescrits et administrés respectivement à 97.30% et 94.50%, le kétoprofène et le tramadol étant utilisés en première intention. Aucun antalgique de palier 3 n'a été utilisé. L'analgésie complète a été obtenue après quatre jours ou plus. 49 patients (67.1%) ont attribué les mentions d'appréciation les plus basses au traitement analgésique reçu et seuls 4 (5.5%) l'ont estimé excellent. Dans 53,42% des cas il a fallu soixante minutes ou plus pour que les différents produits prescrits soient disponibles. Pour tous les patients, aucun traitement n'a permis d'obtenir une analgésie dans les 30 minutes suivant son administration. Conclusion. La majorité des sujets drépanocytaires est insatisfaite du traitement antalgique reçu. Des sessions de formation du personnel sont nécessaires

Pain as a Reason for Primary Care Visits: Cross-Sectional Survey in a Rural and Periurban Health Clinic in the Eastern Cape; South Africa

Background: The burden of pain in primary care has not been described for South Africa. This study aimed to determine the prevalence of pain in primary care and to characterise pain among adult patients attending a rural and a periurban clinic in the Eastern Cape (EC) Province.Method: A cross-sectional descriptive survey was conducted among adult patients attending a rural and periurban clinic over four days. Consecutive patients were asked whether they were in the clinic because of pain and whether the pain was the major reason for their visit. Pain was characterised using an adaptation of the Brief Pain Inventory and the Pain Disability Index. The prevalence percentage and the 95 confidence interval (CI) of pain were estimated; and the relationship with demographic variables was determined at a significance level of P 0.05.Results: Seven hundred and ninety-six adult patients were interviewed; representing a response rate of 97.4. Almost three-quarters (74.6; 95 CI: 63.2-81.4) reported visiting the clinic because of pain. Pain was the primary reason for 393 (49.4; 95 CI: 32.1-61.0) visits and was secondary in 201 (25.3; 95 CI: 12.8-33.7) visits. The common sites of pain were the head; back and chest. The median pain score was eight on a scale of 0-10 (interquartile range: 6-8). Respondents experienced limitations in a number of activities of daily living as a result of pain.Conclusion: Pain is a central problem in public primary care settings in the EC Province and must therefore be a priority area for primary care research. Strategies are needed to develop to improve pain management at primary care level in the province

Exploration of Pain in Children on Antiretroviral Treatment in a Regional Hospital in South Africa

Background: Patients with human immunodeficiency virus (HIV) disease on antiretroviral therapy (ART) may experience pain for a variety of reasons; including the effects of the virus itself; associated opportunistic infections and the ART. Studies indicate that pain in adults on ART is frequent; can be severe; and is often undertreated. This study sought to explore the experience; and the prevalence of pain in young children aged 3-13 years on ART.Method: Primary caregivers of children aged 3-13 years on ART attending a paediatric ART clinic at a regional hospital in Durban participated in the study. Convenience sampling was used. The Wong-Baker FACEST Pain Rating Scale and a questionnaire adapted from Hirshefeld were used to investigate variables such as age; cluster of differentiation 4 (CD4) count; ART regimen; ART duration; and site; prevalence and impact of pain during activities. Data were analysed using a standard statistical programme.Results: Four hundred and twenty primary caregivers were interviewed. Most were mothers caring for their HIV-positive children; and the majority of the children were aged 3-7 years. Most children were on a first-line ART regimen; and half reported pain. Nociceptive pain (visceral or somatic) was the most common type of pain; and pain interfered with the daily activities of a third of the children. There was a significant association between CD4 count and pain (p-value = 0.040). Paracetamol was the most commonly used analgesic.Conclusion: Pain was a common problem; and generally was undertreated with analgesia. A need to improve pain assessment and management in this population group was identified

A Comparison of Post-Incisional Subcutaneous; Intramuscular; and Subcutaneous plus Intramuscular Infiltrations of Lidocaine in Post-Caesarean Pain Control

Background. How best to relieve pain after caesarean section (CS) is still debated by many obstetricians. Pre- and post-incisional infiltrations with local anaesthetics have been widely tested and compared. However; the effect of the site of post-incisional infiltration with a local anaesthetic on the quality of pain reduction is not well documented.Objectives. To compare the effects of post-incisional infiltration of lidocaine into the subcutaneous tissue; rectus abdominis; or both subcutaneous tissue and rectus abdominis on pain after CS.Methods. Two hundred candidates for elective CS were randomly allocated to four matched groups of equal size. They received postincisional infiltration of either 1 lidocaine (in the rectus abdominis; the subcutaneous tissue; or both) or saline. The pain intensity and analgesic demand after CS; as well as the time to ambulation and breastfeeding; were documented and compared between the groups.Results. Post-CS pain intensity and analgesic demand were significantly lower; and the time to ambulation was significantly less; in the lidocaine groups than in the placebo group. The time to breastfeeding; however; was comparable between the two groups. Among the patients who received lidocaine; the site of infiltration was associated with no significant differences in terms of post-CS pain intensity and need for analgesics; or time to ambulation and breastfeeding.Conclusion. The site of post-incisional local wound infiltration with lidocaine is not a clinically important factor in pain relief after CS