A Comparison of Two Regimens for Post-Caesarean Section Analgesia in a Tertiary Health Centre in Northern Nigeria.

BACKGROUND: Post-caesarean section pain is a problem i n our environment. Though many modalities for pain management exist, there is the need to investigate safer and affordable regimens that will provide adequate analgesia with minimal side effects and with ease of administration. Alternating doses of intramuscular acetaminophen and intramuscular pentazocine was studied as an alternative to provide safe and effective post-caesarean section analgesia. Its effectiveness and side effect profile in our environment have not been previously investigated. AIMS AND OBJECTIVES: The study aimed to compare the analgesic and side effect profile of intramuscular pentazocine with another regimen involving alternating doses of pentazocine and acetaminophen within the first 48hours after surgery. DESIGN OF THE STUDY: This was a prospective, comparative and randomized study among 142 women who voluntarily consented to the study and had elective caesarean section from May 2014 to May 2015 at the Ahmadu Bello University Teaching Hospital, Zaria. Setting: The Study was conducted at the obstetrics and gynecology department of the teaching hospital of Ahmadu Bello University, Zaria. MATERIALS AND METHODS: Consecutive eligible pregnant women who were slated for elective caesarean section were recruited at the antenatal clinic unit of the department and randomized using the WINPEPI software by Abramson to either receive intramuscular pentazocine or alternating doses of pentazocine and acetaminophen over the first 48hours after surgery. The pain scores, side effect profile and the time taken for the return of bowel sounds were compared among the two groups using relevant statistical methods with IBM SPSS version 20 with Z tests and chi-square to test for strength of relationships of variables. The level of significance was 0.05. RESULTS: The average age of the participants was 29.82years with standard deviation 6.138; 64.8% were Hausa-Fulani, 71.83% were Muslims, 45.07% were unemployed, 97.89% were married, 42.2% were multiparous, 59.86% booked in our centre and 59.2% were having their first caesarean section. Seventy-six participants received combination of injection pentazocine/acetaminophen while 66 received pentazocine injection alone. The drop-out rate was 8.5%. There was no statistically significant difference in the pain scores both on the visual analogue scale and the verbal rating scale in the first 48hours in both groups, no difference in the need for rescue analgesics (p=0.709), time taken for the return of bowel sounds (P=0.391), incidence of side effects (p=0.394) and participants' level of satisfaction (p=0.255). CONCLUSION: Both regimens were comparable in analgesic efficacy, incidence of side effects and satisfaction levels.

BACKGROUND: La douleur de la césarienne est un problème dans notre environnement. Bien que de nombreuses modalités de gestion de la douleur existent, il est nécessaire de rechercher des régimes plus sûrs et abordables qui fourniront une analgésie adéquate avec des effets secondaires minimes et une facilité d'administration. L'alternance de doses d'acétaminophène intramusculaire et de pentazocine intramusculaire a été étudiée comme une alternative pour fournir une analgésie post-césarienne sûre et efficace. Son efficacité et son profil d'effets secondaires dans notre environnement n'ont pas été étudiés auparavant. BUTS ET OBJECTIFS: L'étude visait à comparer le profil analgésique et des effets secondaires de la pentazocine intramusculaire avec un autre schéma impliquant des doses alternées de pentazocine et d'acétaminophène dans les 48 heures après l'opération. CONCEPTION DE L'ÉTUDE: Il s'agissait d'une étude prospective, comparative et randomisée menée auprès de 142 femmes qui avaient volontairement consenti à l'étude et ayant subi une césarienne élective de mai 2014 à mai 2015 à l'hôpital universitaire Ahmadu Bello, Zaria. Cadre : L'étude a été menée au département d'obstétrique et de gynécologie de l'hôpital universitaire de l'Université Ahmadu Bello, Zaria. MATÉRIEL ET MÉTHODES: Les femmes enceintes admissibles consécutives qui devaient subir une césarienne élective ont été recrutées dans l'unité de clinique prénatale du département et de l'hôpital et randomisées à l'aide du logiciel WINPEPI d'Abramson pour recevoir soit la pentazocine et d'acétaminophène au cours des 48 heures suivant l'opération. Les scores de douleur, le profil des effets secondaires et le temps nécessaire au retour des bruits intestinaux ont été comparés entre les deux groupes en utilisant des méthodes statistiques pertinentes avec version 20 d'IBM SPSS avec des tests Z et des tests de chi-deux pour vérifier la force des relations entre les variables. variables. Le niveau de signification était de 0,05. RÉSULTATS: L'âge moyen des participants était de 29,82 ans avec un écart type de 6,138 ; 64,8% étaient Hausa-Fulani, 71,83% étaient musulmans, 45,07% étaient sans emploi, 97,89 % étaient mariés, 42,2 % étaient multipares, 59,86 % avaient réservé dans notre centre et 59,2 % subissaient leur première césarienne. Soixante-seize participantes ont reçu une combinaison d'injection pentazocine/ acétaminophène tandis que 66 ont reçu l'injection de pentazocine seule. Le taux d'abandon était de 8,5 %. Il n'y avait pas de différence statistiquement significative dans les scores de douleur sur l'échelle visuelle analogique et l'échelle d'évaluation verbale au cours des 48 premières heures dans les deux groupes, pas de différence en ce qui concerne le besoin d'analgésiques de secours (p=0,709), le temps nécessaire au retour des bruits intestinaux (P=0,391), l'incidence des effets secondaires (p=0,394) et le niveau de satisfaction des participants (p=0,255). CONCLUSION: Les deux schémas thérapeutiques étaient comparables en termes d'efficacité analgésique, l'incidence des effets secondaires et le niveau de satisfaction. Mots clés: Analgésie, césarienne, comparatif, pentazocine, acétaminophène, intramusculaire.

A COMPARATIVE STUDY OF INTRAMUSCULAR ACETAMINOPHEN VERSUS INTRAMUSCULAR PENTAZOCINE AS LABOUR ANALGESIA IN ZARIA, NORTHWESTERN NIGERIA.

BACKGROUND: Intramuscular pentazocine is a common labour analgesic in Zaria, Nigeria due to its low cost and availability. Though also cheap and readily available the use of intramuscular acetaminophen is not popular and hence the need for a comparative study. AIM & OBJECTIVES: To compare the efficacy of intramuscular acetaminophen versus intramuscular pentazocine on women in labour as well as the effects of both drugs on APGAR scores of their newborn. METHODOLOGY: A randomized, comparative study was conducted on 188 eligible, parturients from June to September, 2013. The subjects were selected during antenatal classes and early active labour, counseled, taught about the pain scoring systems after obtaining written consent from them. Randomization was done using the WINPEPI software by Abrahamson in order for each woman in labour to receive either intramuscular acetaminophen 15mg/kg stat or pentazocine 1mg/kg at cervical dilatation of 4-6cm. The data obtained included the patients demographics, hourly pain scores, APGAR scores, patients' satisfaction and side effects. RESULTS: The mean age was 28.1years ± SD 5.2years. The majority of the subjects (53.5%) were Hausa-Fulani and 70.1% were muslims; 64% were booked for antenatal care while 58.5% had received secondary school education. The average duration of labour was 5.4hours. Acetaminophen was administered to 91(48%) subjects while pentazocine was administered to 97(52%). Sixty-nine percent and 80% experienced adequate pain relief in the acetaminophen and pentazocine groups respectively at one hour. The pain scores was statistically significant at one hour but comparable in both groups afterwards: p=0.01, 0.52, 0.338 and 0.389 at 1(st), 2(nd), 3(rd) and 4(th) hours on the linear/visual analogue scale and comparable on the verbal rating scale. There was no difference in the 1(st) and 5(th) minute APGAR scores of the babies delivered (p=0.24 and 0.63 respectively). Patients' satisfaction was comparable but the pentazocine group experienced more side effects. CONCLUSION: Intramuscular acetaminophen gave comparable labour analgesia with fewer side effects when compared with pentazocine.

Medication errors in anaesthetic practice: a report of two cases and review of the literature.

BACKGROUND: Mistakes in the identification and administration of drugs may be fatal. This is especially so in the practice of anaesthesia. This is a report of 2 cases of near fatality due to mistakes in drug administration from look-alike medications. OBJECTIVE: To highlight the significance of medication errors in our practice and to discuss the best methods of prevention. METHOD: A report of two cases of errors in the administration of drugs during the conduct of anaesthesia. The subsequent management of the cases is presented, and the findings from the literature are discussed. RESULT: In case 1, an adult male presented for herniorrhaphy and after induction with propofol 1mg/kg intravenously, Pancuronium bromide injection 4 mg was administered intravenously, in the place of suxamethonium chloride injection. In case 2, For induction of anaesthesia, 100mg of thiopentone sodium was administered in place of 25mg of the same drug because Thiopentone 1 gm vial was mistaken for Thiopentone 500 mg vial in a 2 year old girl. In both cases, the errors were detected early and there were no adverse sequelae. CONCLUSION: Medication errors are a potential source of iatrogenic harm to patients undergoing anaesthesia. Strict adherence to principles as well as constant vigilance would minimize this problem.

Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria.

BACKGROUND: The purpose of this study was to assess the attitudes of maternal health care providers to pain relief during labor in Zaria, Nigeria. METHODS: This was a multicenter, collaborative, cross-sectional pilot study of provider perspectives concerning pain relief during labor. A structured, self-administered, questionnaire was completed by 95 consenting maternal health care providers at three high-volume facilities in Zaria, an ancient northern Nigerian city. Descriptive statistics was performed on the data. RESULTS: Most respondents (94.8%) agreed that pain relief is needed during labor. Only 2.1% of respondents were undecided about the provision of pain relief during labor and 3.2% were of the opinion that pain relief was not necessary during labor. Most respondents (93.7%) had attended a woman in labor in the 4 weeks preceding the survey. Of these, 56.8% had counseled a parturient in labor. Most of the counseling (42.1%) took place during labor. Less than half of the respondents (48.4%) had administered pain relief in labor in the preceding 4 weeks and systemic opioids was the most commonly form of pain relief. Among the respondents who did not offer pain relief agents in labor, the majority (54.5%) had no reason for not offering it. Unavailability of methods, inability to afford the cost of pain relief, lack of knowledge and skills, as well as lack of essential equipment to provide the procedure were also given by respondents as reasons for not offering pain relief. CONCLUSION: Even though maternal health care providers in this environment have a positive attitude to pain relief in labor, most women go through labor without the benefit of analgesia. There exists a gap between provider attitudes to pain relief in labor and practice of the same, with many providers having no genuine reason(s) for not offering pain relief to their clients during labor. Providers need to align their practice to their attitudes, and need to be helped to do this through training as well as enhancing their ability to think critically about their practice.