Effectiveness of perineural administration of dexamethasone with lidocaine on onset time of sensory block and early postoperative analgesia in axillary brachial plexus block: a prospective cohort study, Ethiopia.

Introduction: The axillary brachial plexus block is a popular nerve block for forearm, wrist, and hand surgery. The aim of this study was to assess the effectiveness of perineural administration of dexamethasone as an adjunct to lidocaine with adrenaline on the onset of sensory block and early postoperative analgesia in trans-arterial axillary brachial plexus block. Methodology: This single-centered prospective cohort study recruited 68 adult patients, 34 in each groups. The frequently used 8 mg dexamethasone combined with 1% lidocaine and adrenaline was investigated. The normality of the data was checked using the Shapiro-Wilk test. An independent t-test was used to compare the mean values of symmetric numeric data. Categorical variables between the two groups were analyzed using χ2. The Mann-Whitney U test and Kaplan-Meier method using the log-rank test were used to compare asymmetric numeric data, and a P-value of <0.05 was considered as significant. Results: The median onset time of sensory block was comparable between the nonexposed (24(6) min) and exposed group (24(6) min) (P=0.068). However, the duration of sensory block was significantly longer in the exposed group (235.5±37.51 min) than the nonexposed group (172.76±28.19 min) (P<0.001). The time to the first analgesic request was significantly longer in the exposed than the nonexposed group (P<0.01). Postoperative pain scores were significantly lower at 4 and 8 h in the exposed group (P<0.05). Conclusion and recommendations: The addition of 8 mg dexamethasone to 1% lidocaine with adrenaline solution in trans-arterial axillary brachial plexus block for ambulatory elective hand, wrist, and forearm surgeries prolonged the duration of sensory blockade and the first analgesic request time but did not reduce the onset time of sensory block. The authors recommend the addition of 8 mg dexamethasone to 1% lidocaine with adrenaline solution to prolong the duration of sensory block and the first analgesic request time.

Evidence-based guideline on chronic postsurgical pain management in adult patients in resource-restricted setting, 2023: systematic review and guideline.

Background: Chronic postsurgical pain (CPSP) after tissue trauma is frequent and may have a long-lasting impact on the functioning and quality of life. The development of CPSP increases the burden on both the patient and the community. This review aims to systematically review articles and, lastly, pull an evidence-based guideline for CPSP management in adult patients in resource-limited areas. Methodology: The review was reported based on preferred reporting items for the systemic review and meta-analysis (PRISMA) protocol. A literature search was conducted from the Cochrane, PubMed/Medline, and Google Scholar databases, and other gray literature from 2010 to 2022. The conclusion was made based on the level of evidence. Results: A total of 3521 articles were identified through the database by searching strategies. Finally, by filtering duplicates unrelated to the topics, 22 articles (9 meta-analyses and systematic reviews, 12 systematic reviews, and one cohort study) were selected on the management of CPSP in adult patients. Filtering was made based on the intervention, outcome data of the population, and methodological quality. Conclusion: Given the complexity and multidimensional nature of chronic postsurgical pain, effective assessment, and management require a comprehensive, multiaxial approach. Adequate preoperative preparation and counseling, potential risk identification and optimization, and use of a multimodal approach, and noninvasive surgical techniques are crucial in reducing the development of chronic postsurgical pain.

Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures.

Background: Almost all children with burns experience pain as a result of a complex pathophysiologic process that is usually untreated, and up to 38% of all pediatric burn victims develop anxiety disorders due to pain after hospital admission. Hence, it is important to manage pain and anxiety in the care of burn victim children. The goal of this review was to develop an evidence-based guideline for procedural pain management and sedation for burned children undergoing wound care procedures. Methodology: The review was reported according to Reporting Items for practice Guidelines in Healthcare (RIGHT) protocol. A search of literature was done from Cochrane review, PubMed, Google Scholar, Embase, web of science and Hinari database key words "pediatrics", "children", "burn", "procedural wound care", "wound dressing", "non-pharmacological", "analgesia", "pain management" and "sedation" were used. Extraction and filtering of the results was determined based on the interventions, outcome, population, and methodological quality, and inclusion and exclusion criteria. Finally, 6 systematic review and meta-analysis, 1observational study, and 16 randomized control trial Studies were appraised for quality, and conclusion was made based on their level of evidence and grade of recommendation. Conclusion and recommendation: For effective management of procedural pain and accompanying anxiety during WCP in children, we recommend using non-pharmacological strategies as an adjunct with calculated dose of analgesics based on the children's analgesic requirements. We also recommend ketamine-dexmedetomidine as an effective first-line analgesic-sedation, and ketamine-propofol, propofol-remifentanil, propofol-fentanyl, and ketamine-midazolam as useful sedative-analgesic options.

Determinants of neonatal mortality in the neonatal intensive care unit of Dilla University Referral Hospital, Southern Ethiopia; 2019-2020; A matched, case-control study.

Background: Neonatal mortality rate (NMR) refers to the number of deaths occurring from birth to 28 days of life per-1000 Live Births (LB). The global NMR declined from 37 deaths per- 1,000 LB in 1990 to 18 in 2017, whereas it was 27 deaths per 1000 LB in the Sub-Saharan region. Ethiopia plans to reduce the NMR from 28 deaths to 11 deaths per 1,000 LB by 2020 and to end all preventable child deaths by 2035. The aim of this study was to identify the determinants of neonatal mortality in the neonatal intensive care unit (NICU) of Dilla University Referral Hospital (DURH). Methods: An age-matched case control study was conducted at DURH's NICU. Two controls having age 2 days before or after the case were used for matching. One hundred eighteen cases (died) and 236 controls (survived) neonates admitted to the NICU from January 11, 2018, to February 25, 2020, were studied. Missed data were filled by multiple imputations. Multicollinearity was checked by the variance inflation factor. For variables with a P-value <0.2 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was performed to control for confounders using clogit command in a survival package to identify the risk factors for neonatal mortality using R version 3.6.3. Result: Gestational age <37 weeks (Adjusted matched odds ratio (AmOR): 14.02; 95% confidence interval (CI): 3.68-53.46), first-minute APGAR score <7 (AmOR: 5.68; 95% CI: 1.76-18.31), perinatal asphyxia (PNA) (AmOR: 4.62; 95% CI: 1.15-18.53) and being twins (AmOR: 6.84; 95% CI: 1.34-34.96) were significantly associated with neonatal deaths in our study. Furthermore, antenatal care and follow-up during pregnancy (AmOR: 0.15; 95% CI: 0.04-0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95% CI: (0.02-0.66) were found to be determinant of neonatal mortalities in our study. Conclusion: Gestational age less than 37 weeks, first-minute APGAR scores <7, being twins, diagnosis of PNA, antenatal care and follow-up of mothers during pregnancy and normoglycemia in neonates at admission were significant determinant of neonatal death in the NICU of DURH.

Knowledge, attitude, and practice of healthcare workers toward COVID-19 and its prevention in Ethiopia: A multicenter study.

BACKGROUND: An emerging respiratory disease abbreviated as coronavirus disease 2019 was first reported in December 2019 in Wuhan city of China. The virus is zoonotic and tends to be transmitted between animals to humans and humans to humans. The major route of transmission of coronavirus disease 2019 is droplet and close contact. The Ethiopian Ministry of Health has initiated training for health care workers at a different level. Thus, the main objective of this study is to assess the knowledge, attitudes, and practices of health workers in Ethiopia toward coronavirus disease 2019 and its prevention techniques. METHOD: An institution-based multicenter cross-sectional study was conducted in each of eight teaching and referral hospitals. A total of 422 Ethiopian healthcare workers were selected for the assessment of knowledge, attitude, and practice toward coronavirus disease 2019. Data were collected using a structured questionnaire. A logistic regression model was used to identify factors associated with the attitude and knowledge of healthcare workers toward coronavirus disease 2019 at a significance level of p < 0.05. RESULT: Three hundred ninety-seven healthcare workers participated in the study, with a response rate of 94%. Among these, 88.2% and 94.7% of respondents had good knowledge and positive attitudes, respectively. A respondent with a history of chronic medical illness (odds ratio: 0.193, 95% confidence interval: 0.063-0.593), social media, telecommunication, and television/radio as a source of information were significantly associated with knowledge (odds ratio: 3.4, 95% confidence interval: 1.5-7.4, OR: 4.3, 95% confidence interval: 1.3-14.3 and odds ratio: 3.2, 95% confidence interval: 1.4-7.2). In addition, respondents with a history of chronic medical illness were significantly associated with a negative attitude toward coronavirus disease 2019. CONCLUSION: The knowledge and attitude were good while; the practice was relatively low. Sources of information such as social media, telecommunication, and television/radio were positively associated with healthcare workers' knowledge about coronavirus disease 2019.

Comparison of thiopentone with lidocaine spray vs propofol for laryngeal mask airway insertion at tikur anbessa specialized hospital. A prospective cohort study.

BACKGROUND: Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. METHODS: Eighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Manny Whitney test. Categorical data were analyzed by the chi-square test. A p-value ≤ 0.05 was considered a statistically significant difference. RESULT: The comparison of data showed that a significant reduction in mean arterial blood pressure (MAP) in the Propofol group during the first 10 min. The MAP at first minute after LMA insertion was 78.4 ± 5.5 in the Propofol group compared to 81.8 ± 5.6 in thiopentone-lidocaine group p < 0.001. the mean MAP at 5th and 10th minutes after LMA insertion is also significantly lower in the Propofol group compared to the thiopentone-lidocaine group, p < 0.05. There were no statistically significant differences regarding the heart rate change and insertion conditions between the two groups. Mean apneic time was 138 ± 45.8 s in the Propofol group and 85 ± 13.8 s in thiopentone-lidocaine group p < 0.001. Thiopentone-lidocaine group had a lower treatment cost compared to the Propofol group. CONCLUSION: Thiopentone with 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness.

Magnitude and Associated Factors for Attitude and Practice Toward COVID-19 and Its Prevention Among the Residents of Gedeo Zone, Southern Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: COVID-19 first broke out in China, Hubei province on December 29, 2019, since then it took hundreds of thousand lives worldwide. Although all countries are taking varying degrees of measures to curb the dissemination, the virus is still spreading rapidly in all parts of the world. Adherence of people for COVID-19 precaution measures is one of the most important factors which determine the effectiveness of curbing the spread. However, without having a good attitude, the adherence of people toward precaution measures could be challenging. Therefore, this study aims to assess the attitude, practice, and associated factors of Gedeo zone of Southern Ethiopia region residents toward COVID-19 and its prevention. METHODS: A community-based cross-sectional study was conducted among 600 Gedeo zone residents of Southern Ethiopia. Bivariate and multivariate binary logistic regression were used to determine the association between dependent and independent variables. An adjusted odds ratio with 95% CI was used to show the strength of association. P-value<0.05 was used to decide a statistically significant association. RESULTS: Most of the study participants (90.3%) have a good attitude toward COVID-19 and its prevention. Being a younger age group (AOR=3.82, 95% CI=1.76-19.07), having a diploma and above (AOR=2.53, 95% CI=1.15-7.50), having a chronic medical illness (AOR=2.73, 95% CI=1.01-7.44), and using television/radio as a source of information (AOR=2.65, 95% CI=1.27-5.54) were significantly associated with a good attitude toward COVID-19. On the other hand, only 20% of the study participants had good practice toward COVID-19 prevention. Educational status (P-value=0.00), occupation (P-value=0.01), and having a chronic medical illness (P-value=0.03), and use of religious teaching as information sources (P-value=0.02) were among the factors associated with good practice toward COVID-19 infection. CONCLUSION: We conclude that, despite the presence of a good attitude in the majority of respondents, much work is needed to improve the poor practice of COVID-19 preventive measures.

Evidence-Based Guideline for Adult Sedation, Pain Assessment, and Analgesia in a Low Resource Setting Intensive Care Unit: Review Article.

BACKGROUND: Agitation and anxiety occur frequently in ICU and affect about 30-80% of patients in ICU present with delirium worldwide, and it is associated with adverse clinical outcomes. This review aimed to systematically review articles and finally draw an evidence-based guideline for an area with limited resources. METHODS: The review was reported based on preferred reporting items for systemic and meta-analysis (PRISMA) protocol. We searched literature from PubMed, Google Scholar, and Medline database using keywords like the level of sedation, sedation score, pain assessment in ICU, and sedative drugs in ICU from an article published in English. After extraction with a patient population and exclusion, five randomized clinical trials, four systemic reviews and meta-analysis, four observation cohort study, and two practical guidelines were used for the review. CONCLUSION: In addition to high validity and reliability, RASS has the advantage of easiness to remember for nurses making it a preferred sedation assessment tool in an adult ICU setting. Light sedation with daily interruption was recommended with an aim of an awake and alert patient ready for the weaning trial. Propofol was preferred when sedation is for a short duration and when intermittent awakening is required. Ketamine is the preferred induction for asthmatic hypotensive and patient requiring prolonged continuous sedation. With a similar time for sedation, diazepam shows a shorter time for intubation compared to midazolam. Besides diazepam has shown a cheaper cost of sedation than midazolam. This makes it a drug of preference in a low resource setting.

Comparing Analgesic Effect of Intravenous Fentanyl, Femoral Nerve Block and Fascia Iliaca Block During Spinal Anesthesia Positioning in Elective Adult Patients Undergoing Femoral Fracture Surgery: a Randomized Controlled Trial.

BACKGROUND: Femoral fracture is the most painful bone injury and performing spinal anesthesia is extremely challenging due to very poor positioning unless we have a very good mode of analgesia. Intravenous strong opioids are commonly used but to date nerve blocks are also being utilized. The reliability and effectiveness of the aforementioned methods are not conclusive to practice worldwide. The objective of the study was to compare the analgesic effect of intravenous fentanyl, femoral nerve block (FNB) and fascia iliaca block (FICB) during positioning patients with femoral fracture for spinal anesthesia. METHODS: A randomized controlled trial study was conducted on 72 elective adult patients with femoral fracture aged 18-65 years and ASA I and II those were allocated randomly into three groups. The intravenous fentanyl (IVFE) group received 1µg/kg IV fentanyl, FNB group received nerve stimulator guided FNB with 30 mL of 1% lidocaine with adrenaline and FICB group received FICB with 30 mL of 1% lidocaine with adrenaline. Pain intensity in numeric rating score (NRS), time to perform spinal anesthesia, quality of positioning and patient acceptance were assessed. SPSS version 26 and Kruskal-Wallis test were used to analyze data and p value <0.05 was considered significant. RESULTS: NRS Pain score during positioning was significantly lower in FNB and FICB groups than IVFE group [median (IQR)]; 2 (1-2.5), 2 (2-3)) vs. 3 (3-4) respectively; P<0.001 and P=0.001. However, FNB and FICB groups were not significantly different with (P=1.000). Time to perform spinal anesthesia was significantly longer in IVFE group 9.5 (9-10) minutes than both FNB and FICB groups 7 (6-8), 8 (6-8) respectively, P<0.001. The quality of positioning was significantly lower in the IVFE group than both FNB and FICB groups (P<0.001). CONCLUSION: Preoperative FNB and FICB reduce pain score during positioning, shorten time to perform spinal anesthesia, better patient positioning and higher patient acceptance in a patient undergoing elective femoral bone fracture surgery. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR202006669166858, registered on June 19, 2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12127.

Knowledge of COVID-19 and its prevention among residents of the Gedeo zone, South Ethiopia. Sources of information as a factor.

BACKGROUND: COVID-19 was declared as a pandemic in March 2020. After confirming the first case, the Ethiopian government has been working a lot to prevent transmission. Most of the reported cases were identified from traveling abroad. Effective prevention and control practices depend on awareness and compliance among the population at all levels. The main objective of this study is to determine the knowledge level and its association with sources of information towards COVID-19 and its prevention techniques in the Gedeo Zone of Southern Ethiopia. METHODS: There are 10 knowledge questions regarding COVID-19 and its prevention techniques. The maximum knowledge score for each question was 1 and the minimum 0, where 0 was scored for incorrect and 1 for correct answers. The overall knowledge score ranges from 0 to 10, where a score of 0-5 as poor knowledge and a score from 6-10 as good knowledge. Bivariate and multivariate binary logistic regression was used to determine the association between dependent and independent variables. The adjusted odds ratio with their 95% CI was used to show the strength of association. p Value < .05 was used to declare a statistically significant association. RESULTS: Among 1170 study participants, 58.1% of the study participants were male. Protestant constitutes 50.6% of the study participants in religion. Regarding knowledge level, 60.5% have good knowledge about COVID-19 and its prevention techniques. Concerning sources of information about COVID-19 and its prevention; internet, family/peer, religious and health workers contributes less <20% whereas telecommunication and television/Radio contributes the largest 56.1% and 85.8% as a source of information respectively. Internet as a source of information AOR: 1.99 (CI: 1.05-3.78, p = .034), information from health worker AOR: 2.324 (CI: 1.228-4.397, p = .010) and information from television or radio AOR: 2.737 (CI: 1.471-5.092, p = .001) has been significantly associated with good knowledge with p value < .05. CONCLUSION: Sources of information had a significant association on the level of knowledge. Residents who had internet, television/radio, and health workers as their information sources had better knowledge regarding COVID-19 and its prevention. Based on this, we recommend increasing internet access, television and radio service, and public health education by trained health workers for effective approaches to fight COVID-19.