Essential pain management at a rural district hospital in Burundi

Abstract

Background: Pain management is a significant challenge in low- and middle-income countries (LMICs). In settings where resources are limited, interventions to improve pain management must be low-cost and context-appropriate.
Methods: At a rural district hospital in Burundi, East Africa we undertook the delivery of a simple educational workshop called Essential Pain Management (EPM) and introduction of regular acute pain rounds for post-surgical patients. At the same time, we carried out a pre- and post-intervention audit of pain management. We hypothesised that the use of the EPM educational workshop and introduction of regular acute pain rounds for post-surgical patients would lead to a reduction in patient pain scores, time to first ambulation, hospital length of stay, and changes to analgesic medication prescribing practices.
Results: We found improvements in modified visual analogue scale (VAS) scores on postoperative days one (mean VAS 42.3 vs 31.4, p < 0.001) and two (mean VAS 33.7 vs 27, p = 0.001), with no difference on day three. We also found a reduction in time to first ambulation after introduction of this service (median time of 38.8 hours vs 28 hours, p < 0.001) with no change in length of stay (median four days in both groups). There was also a marked increase in administration of analgesic medications after the service was introduced.
Conclusion: Our audit demonstrates a positive impact following a simple low-cost intervention in a rural hospital where resources are severely limited. We believe that this intervention offers a feasible and context-appropriate approach for improving postoperative pain management in a low-resource setting.