RESUMEN
The purpose of the study was to find out the prevalence of chronic pain in economically active population and associated economic loss. This cross-sectional observational study was carried out in 3 VDCs of Sunsari District involving 1730 individuals of 15-64 years age group selected by multistage random sampling. Demographic data, absence or presence of pain, site, severity, duration and relieving measures, approximate expenditure in treating pain and number of days lost due to pain were noted using a preformed questionnaire. Out of 1730 individuals interviewed, 882 (50.1%) had pain of which 93.7% had chronic pain (pain lasting for > 3 months). Backache (25.8%), headache (20.1%) and abdominal pain due to acid peptic disease (12.5%) were the most prevalent painful conditions. About 14.0% of individuals had severe grade pain. Female sex, age e"30 years, lack of formal schooling, smoking habit and dependent status were associated with higher prevalence of pain. Almost 19.0% of individuals with pain were unable to go to work the previous day. Man-days loss due to pain was 1.37 days/month/person in the study population. In terms of cost, pain related losses were Nepalese Rupees (NRs) 1671.89/person/year as against the per capita GDP of NRs 98,640.00 (US$ 1370.0). The money incurred by individuals for therapy on pain was NRs 760.15/person/year. In conclusion, probably first time, we are reporting the prevalence of chronic pain in our communities with people having to spend significant portion of their scarce income (and country's GDP) to treat pain, thus, highlighting it as a public health problem.
Asunto(s)
Adulto , Enfermedad Crónica , Costo de Enfermedad , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Masculino , Nepal/epidemiología , Dolor/economía , PrevalenciaRESUMEN
Quality of anaesthetic care can be improved only after identifying the factors contributing to patients' discomforts and dissatisfaction. The purpose of this prospective observational study was to assess the quality of central neural blocks in terms of physiological alterations and undesired events and to find out modifiable factors associated with patients' discomforts and dissatisfaction. Total 204 female patients (ASA I and II) undergoing gynaecological surgeries received either of the subarachnoid block (SAB), combined spinal epidural anaesthesia (CSEA) or lumbar epidural anaesthesia (LEA) depending on the nature of the procedure. Intra-operative and immediate post-operative physiologic alterations and undesired effects, surgeons' rating of the operation condition and patient satisfaction (using 10 cm visual analogue scale) and acceptability of the technique were analyzed. Out of 204 patients, hypotension, bradycardia and nausea occurred in 45.1%, 17.6% and 14.7% respectively. Fifty-six (27.4%) patients experienced discomforts whereas 10.8% had tolerable pain and 4.9% patients required conversion to general anaesthesia. The main causes of discomfort in these patients were inability to move lower limbs in 35.7% and discomfort in the upper limbs in 32.1% of patients. Operating conditions were suboptimal and unacceptable in 3.9% and 4.3% of patients respectively. The mean patient satisfaction VAS score was 8.2 +/- 1.3 and patient acceptability was 90.2%. Significant failure or unacceptability (approximately in 10.0%) along with a high incidence of preventable discomforts demand improvement in preoperative patient education, intra-operative care and liberal uses of sedation to improve the quality to bring the acceptability closer to 100.0%.