ABSTRACT
INTRODUCTION: Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries. OBJECTIVES: This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa. METHOD: A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa. RESULTS: Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores. CONCLUSION: The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.
ABSTRACT
Introducción: El bloqueo peribulbar, fue por primera vez descrito por Davis y Mandel en 1986. Se considera seguro y eficaz, por lo que estaría indicado tanto en pacientes ancianos con enfermedades asociadas, como en el paciente ambulatorio Objetivo: Identificar la eficacia y seguridad del bloqueo peribulbar para la procedimiento quirúrgico de cataratas. Material y método: Se realizó un estudio retrospectivo que incluyó 470 pacientes que recibieron bloqueo peribulbar para procedimiento quirúrgico de cataratas durante el periodo 1995-2000 en Grey's Hospital, Sudáfrica: Todas las historias clínicas y anestésicas fueron revisadas y la información obtenida analizada cuidadosamente. Resultados: 74.5 % de los pacientes era mayor de 70 años, y 66.8 % padecía de enfermedades crónicas; solo 23.2 % recibió sedación durante la realización del bloqueo. Como parte de la técnica y para la analgesia, se administró alfentanilo. 94.6 % de los pacientes recibió una inyección única y en todos se empleó la combinación de lidocaína y bupivacaina. 97.5 % de los bloqueos fueron exitosos y 16.11 % sufrió algún tipo de complicación. Todas fueron complicaciones menores excepto dos casos de infarto agudo del miocardio (IMA). Conclusiones: El bloqueo peribulbar tiene una alta eficacia, pero aunque menos frecuentes que con el bloqueo retrobulbar, sus complicaciones pueden variar desde triviales hasta devastadoras tanto para la vida como para la visión.
Introduction: Peribulbar blockade was first described by Davis and Mandel in 1986. It is a safe and effective procedure and thus is indicated in patients presenting with associated diseases and in ambulatory patient. Objective: To identify the effectiveness and safety of peribulbar blockade for surgical procedure of cataract. Material and Methods: We made a retrospective study including 470 patients underwent to peribulbar blockade for surgical procedure of cataract during 1995-2000 in Grey's Hospital, South Africa. All medical records and anesthesia were reviewed and the information was carefully analyzed. Results: The 74.5% of patient were older than 70 years old, and the 66.8% presenting with chronic diseases' only the 23.2% had sedation during performing of blockade. As part of technique and for analgesia, we administered Phentanyl. The 94.6% of patients had an only injection, and in all of them we used Lidocaine and Bupivacaine combined. The 97.5% of blockades was successful, and the 16.11% there was some type of complication. All of complications were minor but two cases of myocardial acute infarction. Conclusions: Peribulbar blockade has a high efficacy, but although less frequent than the retrobulbar blockade one; its complications may to vary from trivial to devastating for life and for vision.
