Research Articles

Acute postoperative pain in 1 231 patients at a developing country referral hospital: incidence and risk factors

Adriaan A. Murray, Francois W. Retief
Southern African Journal of Anaesthesia and Analgesia | Vol 22, No 1 | a832 | DOI: https://doi.org/10.1080/22201181.2015.1115608 | © 2016 Adriaan Albertus Murray, Francois Wilhelm Retief | This work is licensed under Other
Submitted: 03 November 2025 | Published: 17 March 2016

About the author(s)

Adriaan A. Murray, Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
Francois W. Retief, Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa

Full Text:

PDF (147KB)

Abstract

Background: Postoperative pain is poorly studied in developing countries. At a Western Cape referral hospital, it was aimed to determine the incidence of acute postoperative pain, to identify populations associated with a higher risk thereof (in order to guide resource allocation) and to investigate whether inexpensive analgesic modalities are currently utilised maximally.
Methods: Patients completed visual analogue scales 24 h after surgery for pain immediately after surgery, maximum pain since surgery and current pain. The incidence of moderate or severe pain and median pain scores were calculated for each scale and for different patient populations. Post hoc logistic regression was performed. Morphine prescriptions were compared with the actual administration thereof.
Results: Of 1 231 patients, 62% indicated their maximum pain as moderate or severe. Procedures with the highest incidences were caesarean section and lower limb orthopaedic surgery (> 80%). Younger age, female gender, emergency surgery, and surgery to the abdomen and lower limbs were associated with higher incidences. Patients experiencing moderate or severe pain received 46% of their prescribed morphine.
Conclusion: In this institution, the incidence of postoperative pain is high as expected. Associations with postoperative pain are identified, which may guide resource allocation. At least one low-cost analgesic modality is currently underutilised.

Keywords

postoperative pain; incidence; risk factors; developing country; health resources; analgesia

Metrics

Total abstract views: 344
Total article views: 163

 

Crossref Citations

1. Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana
Awube Menlah, Isabella Garti, Sarah Ama Amoo, Confidence Alorse Atakro, Caleb Amponsah, Dorcas Frempomaa Agyare
SAGE Open Nursing  vol: 4  year: 2018  
doi: 10.1177/2377960818790383

2. Congruence between nurses' and patients' assessment of postoperative pain: a literature review
Sarah Wooldridge, Jonathan Branney
British Journal of Nursing  vol: 29  issue: 4  first page: 212  year: 2020  
doi: 10.12968/bjon.2020.29.4.212

3. Prevalence and associated factors of acute postoperative pain in adult surgical patients: A prospective study
Eyob Asefa Bekele, Tseganesh Berhanu Tulu, Yonathan Abebe Bulto, Gebeyehu Tessema Azibte, Waltengus Birhanu
Surgery in Practice and Science  vol: 19  first page: 100262  year: 2024  
doi: 10.1016/j.sipas.2024.100262

4. Letter to the Editor: Enhanced recovery after caesarean section - a call to action
Z Jooma, T Kleyenstuber, JA van Niekerk
Southern African Journal of Anaesthesia and Analgesia  vol: 31  issue: 5  first page: 159  year: 2025  
doi: 10.36303/SAJAA.3290

5. Cerrahi Girişim Geçiren Hastaların Beslenme Durumlarının Ağrı ve Mobilizasyona Etkisinin İncelenmesi
Melike ERTEM, Ayşegül SAVCI
Balıkesır Health Sciences Journal  year: 2022  
doi: 10.53424/balikesirsbd.1093063

6. The prevalence of postoperative pain and its association with preoperative anxiety: A cross-sectional study at a tertiary hospital in Johannesburg, South Africa
Amma Antwi, Nana-Yaa Fening, Brian Gardner
Southern African Journal of Anaesthesia and Analgesia  vol: 32  issue: 1  year: 2026  
doi: 10.4102/SAJAA.v32i1.1552

7. Quality of postoperative pain management in Ethiopia: A prospective longitudinal study
Million Tesfaye Eshete, Petra I. Baeumler, Matthias Siebeck, Markos Tesfaye, Abraham Haileamlak, Girma G. Michael, Yemane Ayele, Dominik Irnich, Yan Li
PLOS ONE  vol: 14  issue: 5  first page: e0215563  year: 2019  
doi: 10.1371/journal.pone.0215563

8. Pain assessment and management: An audit of practice at a tertiary hospital
Agya B.A. Prempeh, Rowan Duys, Alma de Vaal, Romy Parker
Health SA Gesondheid  vol: 25  year: 2020  
doi: 10.4102/hsag.v25i0.1281

9. Incidence and associated factors of acute postoperative pain within the first 24 h in women undergoing cesarean delivery at a resource-limited setting in Addis Ababa, Ethiopia: A prospective observational study
Dagim Bimrew, Abebaw Misganaw, Hirbo Samuel, Tenbite Daniel Desta, Samuel Debas Bayable
SAGE Open Medicine  vol: 10  year: 2022  
doi: 10.1177/20503121221133190

10. Prevalence and Factors Associated with Postoperative Pain After Cesarean Section at a Comprehensive Specialized Hospital in Northwest Ethiopia: Prospective Observational Study
Getamesay Demelash, Yophtahe Woldegerima Berhe, Amare Hailekiros Gebregzi, Wubie Birlie Chekol
Open Access Surgery  vol: Volume 15  first page: 1  year: 2022  
doi: 10.2147/OAS.S347920

11. Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa
Lejun Gao, Huaixin Mu, Yun Lin, Qingping Wen, Peng Gao
Journal of Pain Research  vol: Volume 16  first page: 1767  year: 2023  
doi: 10.2147/JPR.S405574

12. The prevalence of moderate-to-severe rebound pain after spinal caesarean section at Tygerberg Hospital following new analgesia guidelines implementation
M du Toit, S Chetty, K Sankar, R Parker, FW Retief
Southern African Journal of Anaesthesia and Analgesia  vol: 31  issue: 3  first page: 72  year: 2025  
doi: 10.36303/SAJAA.3123

13. The effectiveness of a training program based on the Human Caring Theory to caring behaviors and post-cesarean caring outcomes
Elif Keten Edis, Özen Kulakaç
Health Care for Women International  vol: 46  issue: 3  first page: 232  year: 2025  
doi: 10.1080/07399332.2023.2192184

14. Understanding midwife-related factors in post-caesarean pain management: A qualitative study
Philimon Gyapong, David Tenkorang-Twum
International Journal of Africa Nursing Sciences  vol: 25  first page: 101065  year: 2026  
doi: 10.1016/j.ijans.2026.101065

15. Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study
Vanessa Booysen, Johanita R. Burger, Jesslee M. du Plessis, Marike Cockeran
International Journal of Orthopaedic and Trauma Nursing  vol: 36  first page: 100718  year: 2020  
doi: 10.1016/j.ijotn.2019.100718

16. Regional methods of analgesia in the complex of anesthetic support of laparoscopic interventions in emergency surgery (current state of the issue)
V. S. Popova, A. A. Malyshev, A. V. Vlasenko, E. P. Rodionov, E. A. Evdokimov, S. A. Osipov, V. I. Makovey, V. N. Lykhin, A. A. Medvedeva
Medical alphabet  issue: 3  first page: 35  year: 2025  
doi: 10.33667/2078-5631-2025-3-35-45

17. Investigating Relationships Between Pain, Comfort, Anxiety and Depression in Surgical Patients
Kevser Karacabay, Ayşegül Savcı, Filiz Kabu Hergül
Cyprus Journal of Medical Sciences  vol: 7  issue: 7  first page: 40  year: 2022  
doi: 10.4274/cjms.2020.1758

18. Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea
Betiel Yihdego Kidanemariam, Traudl Elsholz, Laban L. Simel, Eyasu H. Tesfamariam, Yonatan Mehari Andemeskel
BMC Nursing  vol: 19  issue: 1  year: 2020  
doi: 10.1186/s12912-020-00492-0

19. The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study
Million Tesfaye Eshete, Petra I. Baeumler, Matthias Siebeck, Markos Tesfaye, Dereje Wonde, Abraham Haileamlak, Girma G. Michael, Yemane Ayele, Dominik Irnich, Alexandra Sawyer
PLOS ONE  vol: 14  issue: 3  first page: e0213644  year: 2019  
doi: 10.1371/journal.pone.0213644

20. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines
Federico Coccolini, Francesco Corradi, Massimo Sartelli, Raul Coimbra, Igor A. Kryvoruchko, Ari Leppaniemi, Krstina Doklestic, Elena Bignami, Giandomenico Biancofiore, Miklosh Bala, Ceresoli Marco, Dimitris Damaskos, Walt L. Biffl, Paola Fugazzola, Domenico Santonastaso, Vanni Agnoletti, Catia Sbarbaro, Mirco Nacoti, Timothy C. Hardcastle, Diego Mariani, Belinda De Simone, Matti Tolonen, Chad Ball, Mauro Podda, Isidoro Di Carlo, Salomone Di Saverio, Pradeep Navsaria, Luigi Bonavina, Fikri Abu-Zidan, Kjetil Soreide, Gustavo P. Fraga, Vanessa Henriques Carvalho, Sergio Faria Batista, Andreas Hecker, Alessandro Cucchetti, Giorgio Ercolani, Dario Tartaglia, Joseph M. Galante, Imtiaz Wani, Hayato Kurihara, Edward Tan, Andrey Litvin, Rita Maria Melotti, Gabriele Sganga, Tamara Zoro, Alessandro Isirdi, Nicola De’Angelis, Dieter G. Weber, Adrien M. Hodonou, Richard tenBroek, Dario Parini, Jim Khan, Giovanni Sbrana, Carlo Coniglio, Antonino Giarratano, Angelo Gratarola, Claudia Zaghi, Oreste Romeo, Michael Kelly, Francesco Forfori, Massimo Chiarugi, Ernest E. Moore, Fausto Catena, Manu L. N. G. Malbrain
World Journal of Emergency Surgery  vol: 17  issue: 1  year: 2022  
doi: 10.1186/s13017-022-00455-7

21. Effectiveness of Pain Control of Local Anaesthetic Wound Infusion Following Elective Midline Laparotomy: A Randomized Trial
Daniel Gathege, Abdallah Abdulkarim, David Odaba, Stanley Mugambi
World Journal of Surgery  vol: 45  issue: 7  first page: 2100  year: 2021  
doi: 10.1007/s00268-021-06072-w

22.

Prevalence and Risk Factors for Acute Postoperative Pain After Elective Orthopedic and General Surgery at a Tertiary Referral Hospital in Tanzania


Ansbert S Ndebea, Sandra AS van den Heuvel, Rogers Temu, Mwemezi M Kaino, Regina LM van Boekel, Monique AH Steegers
Journal of Pain Research  vol: Volume 13  first page: 3005  year: 2020  
doi: 10.2147/JPR.S258954

23. Post-caesarean delivery analgesia in resource-limited settings: a narrative review
D.G. Bishop, M.W. Gibbs, R.A. Dyer
International Journal of Obstetric Anesthesia  vol: 40  first page: 119  year: 2019  
doi: 10.1016/j.ijoa.2019.05.009

24. Voices of surgical wards nurses on barriers hindering acute post-operative pain management at Tshwane municipality, South Africa
Nnene Melia Makou, Melitah Molatelo Rasweswe, Ramadimetja Shirley Mooa, Vanessa Carels
PLOS ONE  vol: 20  issue: 2  first page: e0316809  year: 2025  
doi: 10.1371/journal.pone.0316809

25. Quality of anaesthesia care in elective surgery at a Western Cape academic hospital in South Africa: a perioperative patient satisfaction survey
C Mathews, L Firfiray
Southern African Journal of Anaesthesia and Analgesia  vol: 29  issue: 6  first page: 209  year: 2023  
doi: 10.36303/SAJAA.3009

26. Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study
Jorge Salazar-Flórez, Leidy Arenas-Cardona, Ninemy Marhx, Eduardo López-Guerrero, Ángela Echeverri-Rendón, Luz Giraldo-Cardona
Local and Regional Anesthesia  vol: Volume 17  first page: 39  year: 2024  
doi: 10.2147/LRA.S444947

27. The Effect of Su Jok on Pain, Anxiety, and Quality of Recovery After Lumbar Disk Surgery: A randomized, controlled study
Niran Coban, Sonay Goktas
Journal of PeriAnesthesia Nursing  vol: 41  issue: 1  first page: 54  year: 2026  
doi: 10.1016/j.jopan.2025.04.010

28. A Bibliometric Analysis of Published Literature in Postoperative Pain in Elderly Patients in Low- and Middle-Income Countries
João Batista Santos Garcia, Érica Brandão de Moraes, José Osvaldo Barbosa Neto
Journal of Clinical Medicine  vol: 10  issue: 11  first page: 2334  year: 2021  
doi: 10.3390/jcm10112334

29. Postoperative analgesia. Guidelines
Aleksey M. Ovechkin, A. Zh. Bayalieva, A. A. Ezhevskaya, A. A. Eremenko, D. V. Zabolotskij, I.B. Zabolotskikh, A. E. Karelov, V. A. Koryachkin, A. P. Spasova, V. E. Khoronenko, D. N. Uvarov, G. E. Ulrikh, R. V. Shadrin
Annals of Critical Care  issue: 4  first page: 9  year: 2019  
doi: 10.21320/1818-474X-2019-4-9-33

30. Incidence and predictors of postoperative severe acute pain within 24 hours after cesarean section performed under spinal anesthesia at public hospitals in West Shoa, Ethiopia, 2022 prospective cohort study
Zenebe Bekele, Mulatu Ayana, Merga Haile, Adamu Tesfaye, Asaminew Tasew
Annals of Medicine & Surgery  vol: 85  issue: 9  first page: 4239  year: 2023  
doi: 10.1097/MS9.0000000000001031

31. Efficacy of interfascial blockades in pediatric laparoscopic surgery: a single-center randomized study
A.V. Barminskiy, A.N. Egorov, M.Yu. Kirov
Russian Journal of Anesthesiology and Reanimatology  issue: 6  first page: 28  year: 2025  
doi: 10.17116/anaesthesiology202506128

32. Group-based trajectory analysis of acute pain after spine surgery and risk factors for rebound pain
Yi-Shiuan Li, Kuang-Yi Chang, Shih-Pin Lin, Ming-Chau Chang, Wen-Kuei Chang
Frontiers in Medicine  vol: 9  year: 2022  
doi: 10.3389/fmed.2022.907126

33. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis
Michael M H Yang, Rebecca L Hartley, Alexander A Leung, Paul E Ronksley, Nathalie Jetté, Steven Casha, Jay Riva-Cambrin
BMJ Open  vol: 9  issue: 4  first page: e025091  year: 2019  
doi: 10.1136/bmjopen-2018-025091

34. Nurses’ Priorities for Perioperative Research in Africa
Gillian J. Bedwell, Juan Scribante, Tigist D. Adane, Judita Bila, Caritas Chiura, Priscilla Chizombwe, Betsy Deen, Lucy Dodoli, Mahmoud M. A. Elfiky, Ifeoluwapo Kolawole, Tina Makwaza, Seleman Badrlie M’Baluku, Gaone Mogapi, Christine Musee, Dominic Mutua, Worku Misganaw, Jessy Nyirenda, Lucia Ojewale, Uwayesu Roda, Bruce M. Biccard
Anesthesia & Analgesia  vol: 136  issue: 1  first page: 17  year: 2023  
doi: 10.1213/ANE.0000000000006060

35. Prevalence and Factors Associated with Acute Postoperative Pain after Emergency Abdominal Surgery
Ezra Ejegu Mehari, Yosef Belay Bizuneh, Demeke Yilkal Fentie, Nurhusen Riskey Arefayne
The Open Pain Journal  vol: 15  issue: 1  year: 2022  
doi: 10.2174/18763863-v15-e2208250