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Article Number: EC2/2015/069

Authors: Priscilla Mawuli Awo Ekpale

Topic: Clinical Research



A prospective study was carried out in the pediatric surgery ward of the Korle Bu Teaching Hospital (KBTH) to assess the post-operative pain management needs of pediatric patients on admission at the unit. This study was carried out with the aid of a structured questionnaire and a data collection tool (appendix 2). The total number of patients on admission during this study was 11 and these were patients who had undergone some form of surgery within the 24 hours of 3rd November 2014 and were subsequently monitored for 72 hours.

Out of a total of 9 professionals present during the study, 44.4%, 28.6%, 22.22% and 11.11% were consultants, nurses, residents and house officers respectively. Also 44.44%, 33.33% and 22.22% of the clinicians ascribed their choice of analgesics to guidelines, availability and other reasons respectively. It was however found out that no clinician chose opioids as a first line in the management of post-operative pain irrespective of the level of pain experienced by the patient. Furthermore, there was no standardized method for pain assessment, with crying or wailing being the only indicator of pain and other non-pharmacological methods for pain management were also totally absent.

The post-operative need of the patient who undergoes surgery at the pediatric surgery ward of the Korle-bu Teaching Hospital(KBTH) is some how being met but much improvement is needed in terms of pain assessment and management.



    COMMENT - 1

  • MELISA PEREIRA (Viewer) 16th Nov 2015 - 12:45 PM
    1) Which international/ national pain management guidelines are being followed by the HCPs at Korle-Bu Teaching Hospital ?

  • COMMENT - 2

  • MELISA PEREIRA (Viewer) 16th Nov 2015 - 12:56 PM
    2) Can you please explain about the data collection tool (appendix 2) designed to assess the pain of the patients?

  • COMMENT - 3

  • Priscilla Mawuli Awo Ekpale (Author) 16th Nov 2015 - 6:50 PM
    1) The HCP at Pediatric surgery unit of the Korle-Bu Teaching Hospital where this study was done do not have any International Post Operative pain management guideline they follow but their choice and style of pain management is based on experience over the years with practice.

  • COMMENT - 4

  • Priscilla Mawuli Awo Ekpale (Author) 16th Nov 2015 - 7:00 PM
    2) The data collection tool(Appendix 2) was used together with the FLACC pain scale (for children within the ages of 2-7years ) and the NIP's Pain scale (for Neonates to babies of age 1year) to determine the pain score which was one viable on the data collection tool(Appendix 2). The pain scales were stated in the methodology but was unfortunately not uploaded in the submission.

  • COMMENT - 5

  • GABRIEL OMONIYI AYENI (Viewer) 19th Nov 2015 - 12:21 AM
    Dear author, weldone.

    Please do nurses, house officer prescribed to such categories of patient
    Do nurses, prescribe drugs in your hospital
    Which guideline were you referring to in your work as your earlier response acknowledge that there was no guideline in use in your hospital for pain management
    Are there 'standardized' method aside crying, walling etc as been used by your clinician, to assess presence of pain in paediatric?
    What kind of improvement is expected as reflected in the concluding part of your abstract?
    What is the clinical or public health significance of your work?


  • COMMENT - 6

  • Kavita Gupta (Viewer) 19th Nov 2015 - 5:08 PM
    Dear Priscilla Mawuli Awo Ekpale,
    I would like to appreciate the efforts being made by you.
    The article is well written and informative too.
    However, there are some points missing.
    1. No ethical approval. Though you have mentioned the reason, yet while submitting the article for publication further, it will require ethical approval as any study involving human participants requires ethical approval.

    2. No informed consent obtained. In case of minors, you should have obtained informed consent duly signed by the guardians.

    3. It is advisable that you should have added some more information in the conclusion part of your study.

    Thanking you,


    Thanking you

  • COMMENT - 7

  • Dr Bashir Adam Yakasai (Viewer) 20th Nov 2015 - 5:48 AM
    Dear Priscilla,

    Please, you would need to explain better the methodology and data collection in the children. Did you base your finding from the children wailing as a sign of pain or did you base it on the nurses/doctors observation while filling the questionnaires?

  • COMMENT - 8

  • Dr. AJIT V PANDYA (Viewer) 20th Nov 2015 - 10:31 PM
    1. drug induced pain relief or sedatives drugs are considered in this study ? at what level it works ?

  • COMMENT - 9

  • Priscilla Mawuli Awo Ekpale (Author) 21st Nov 2015 - 11:19 AM
    Dear Ayeni Gabriel Omoniyi,
    As stated in my objectives of the study; it was tto access what guides post operative pain management in the unit. From the results it was realised that all the doctors based their selection of pain control on experience, The outcome of the study has resulted in a discussion between i the unit's pharmacists and the Doctors to put together a pain management protocol that would follow international guidelines.
    Secondly, the guide i made mention of in the methodology for the accessment of pain was the the Internationally accepted FLACC and NInately i forgot to attach copies of those when i was submitting the paper. But that is readily available on line. Those two pain scale was used to access and score the pain of the subjects. Thank you

  • COMMENT - 10

  • Priscilla Mawuli Awo Ekpale (Author) 21st Nov 2015 - 11:23 AM
    Dear kavita guptam,
    Thank you for your comments.
    As i explained in my write up, i did not seek ethical approval as of when i did the work but i did not further get the written concern from the mothers of the subjects because after the study most of the subjects had been discharged and i taught since the verbal approval has been given that was okay.
    Thank you

  • COMMENT - 11

  • Priscilla Mawuli Awo Ekpale (Author) 21st Nov 2015 - 11:34 AM
    Dear Dr Bashir Adam Yakasai.,
    Thank you for your comment.
    Please about the methodology of the study;
    The gurdians of the subjects were informed about the study and their approval was sought verbally. there two data collection form designed and used for the study(appendix 1 and appendix 2) as stated in the write up. The appendix 1 was a questionnaire that was completed by the Doctors and Nurses in the unit. It was to access their knowledge on pain assessment and its control in children whilst the appendix 2 was a data collection tool used on the subjects. The pain accessment scaleas FLACC and the Nips (Appendices 3 and 4 )were used to access and score the subjects pain and this was recorded in the appendix 2 for each subject. So subjects pain accessment was not only based on their crying or the absence of that.
    Please i hope i have well explained my methodology

  • COMMENT - 12

  • Priscilla Mawuli Awo Ekpale (Author) 21st Nov 2015 - 11:38 AM
    Dear Dr. AJIT V PANDYA ,
    Please could you kindly explain further your question. I do not really get it.
    Thank you.