3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Time until first analgesic requirement, post caesarean section under spinal anaesthesia, in HIV-positive patients at Chris Hani Baragwanath Hospital(2011-10-11) Wagner, Janine LouiseBACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.Item Determining the post-operative opioid requirements of patients post total abdominal hysterectomy with a bupivacaine infusion in the incisional site(2010-10-12) Russell, Samantha LeePostoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.Item Pain assessment and management in the critically ill unconscious patient in the adult intensive care units(2010-06-25T11:02:25Z) Ofori, Bridget SenanuCritically ill patients are particularly vulnerable to pain as a result of the severity of their disease conditions, diagnostic and treatment interventions but pain management is not considered a priority in the Intensive Care Unit (ICU) team (Holden, 1991: Walsh & Ford, 1992). Pain causes complications in the ICU patient, which increases their ICU stay and cost of ICU treatment (Pooler-Lunse & Price, 1992). The purpose of this study was to describe the parameters identified by ICU nurses that can be used to assess pain in the critically ill unconscious patient in the adult Intensive Care Units and whether these parameters are considered by the ICU nurses when managing the unconscious patients’ pain. The objectives of the study were to describe the parameters identified by ICU nurses that can be used for assessing pain in unconscious patients and to determine whether these parameters were considered by ICU nurses when managing the unconscious patient’s pain. A non-experimental, descriptive, prospective, comparative, two part design was used for the study. The sample comprised of ICU nurses (n = 40) in four adult ICU’s and the unconscious patients (n = 40) they nursed. Part one involved the nurses’ responses to a self administered Likert-type questionnaire about parameters that could be indicative of pain in the unconscious patient and part two involved a prospective record review of the unconscious patients ICU charts. A comparison was then done between these two parts to determine if the parameters identified by ICU nurses that could be indicative of pain in the unconscious patient, were considered in their management of the unconscious patients pain. Descriptive statistics were used to analyse data. Of the responses elicited from the questionnaire, ICU nurses agreed that raised blood pressure, pyrexia, increased respiratory rate, dilated pupils and increased heart rate could all be indicative of pain in the unconscious patient but these did not influence their management of the unconscious patient’s pain.