Patient and practitioner perspectives on postoperative pain control in Kumasi, Ghana

Objective: The treatment of pain has gained momentum in health care around the world. Nevertheless, pain is undertreated, particularly in the developing world. We sought to compare patient and healthcare practitioner perspectives of postoperative pain and assess perioperative analgesia utilisation in a tertiary care hospital in a resource-limited setting. Design: We conducted a prospective observational study. Setting and subjects: Postoperative patients and their respective recovery room nurses were studied at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Outcome measures: Patients were surveyed 1-4 hours postoperatively. Pain severity on a numerical rating scale (NRS) and patient satisfaction with the pain control were assessed. Recovery room nurses who were responsible for administering the pain medications were surveyed on their perceptions of their patients' pain. Patient demographic information, diagnoses, surgery type, mode of anaesthesia and perioperative analgesia use were recorded. Results: One hundred and four patients aged 42.1 years ± 17.8 were interviewed over an eight-week period in 2010. Of the 104 patients, 58 (55.8%) underwent general anaesthesia and 39 (37.5%) spinal anaesthesia. Seventy-eight patients (75%) received intraoperative analgesia. Eighty-nine patients (86.5%) were prescribed postoperative analgesia. Only 27 (26%) had received any analgesia by the time they were surveyed. All postoperative analgesia was administered intramuscularly. Thirtysix patients (34.6%) rated their pain as severe (NRS 7-10). Overall, nurses perceived patients' pain to be lower than patients' own rating [a mean difference 1.26 units, 95% confidence interval (CI): 0.57-1.95, p-value < 0.001]. Patients were 2.77 times as likely to rate their pain as severe compared to nurses (relative risk: 2.77, 95% CI: 1.56-4.91). Conclusion: There was significant discrepancy in the perception of pain between patients and healthcare providers. Simple pain assessment tools and the early institution of intravenous postoperative analgesia may improve postoperative pain assessment and treatment.