Browsing by Author "van Dyk, Dominique"
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- ItemOpen AccessA retrospective audit of pain assessment and management post caesarean section at New Somerset Hospital in Cape Town, South Africa(2022) Munsaka, Effraim Frackson; van Dyk, Dominique; Parker, RomyBackground: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain, (a risk factor for postpartum depression), as well as optimize maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-caesarean section analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with reference to perioperative pain management guidelines for CS. Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed. Results: The women were a mean age of 30 years (SD 6.2). Median gravidity was 3 (IQR 2-3) and parity was 1 (IQR 1-2); 52% had previously undergone a CS. In 93.3%, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti inflammatory drugs (NSAIDs) were prescribed in < 1.67% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies. Conclusions: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospitals require post-CS pain protocols to guide management especially in resource-limited settings.
- ItemOpen AccessDocumentation of spinal anaesthesia technique and block level at caesarean section(2021) Du Toit, Michiel Adriaan; van Dyk, Dominique; Dyer, Robert ABackground The ease of administration and relative safety of spinal anaesthesia has made this the preferred technique for elective and many emergency caesarean sections. Complications include incomplete sensory block, resulting in intraoperative breakthrough pain, which is commonly associated with a successful medicolegal claim. If documentation of spinal anaesthesia technique was found to be inadequate in the course of such medicolegal proceedings, it is likely that the decision would be against the anaesthetist. The purpose of this study was to evaluate documentation by anaesthetists relating to the establishment of surgical anaesthesia utilizing subarachnoid block. Methods A retrospective folder analysis was conducted at Mowbray Maternity Hospital in Cape Town, South Africa. One hundred consecutive spinal anaesthesia charts, each completed by a different anaesthetist, either a registrar or specialist, were analysed, starting December 31st, 2018, and proceeding retrospectively in time until the sample size was achieved. Results Of the 100 cases of spinal anaesthesia for caesarean section analysed, 68 were emergency and 32 elective operations. After literature review, 12 variables were identified requiring documentation, so that adequate information would be available in the event of medicolegal action. In 23% and 32% of patients respectively, 7 or 8/12 were recorded. Ninety percent of anaesthesia charts had inadequate documentation, defined as information on fewer than 10 of the specified variables. Conclusion The quality of documentation of procedure and block level during spinal anaesthesia for caesarean section was inadequate. National guidelines should be drafted and standardised to improve the quality of these records, both for quality of care and medicolegal purposes.
- ItemOpen AccessKnowledge of South African anaesthesia registrars of the theory and practice of spinal anaesthesia for caesarean section(2023) Ras, Willem; van Dyk, Dominique; Dyer RobertBackground Adequate documentation of details relating to spinal anaesthesia for caesarean section is important, both to ensure a safe and pleasant experience for the parturient, and to provide evidence that an acceptable standard of care was applied in the event of subsequent medicolegal action. On the basis of recent research conducted at the University of Cape Town, documentation of details of spinal anaesthesia at a level 2 obstetrics hospital was inadequate. In the aforementioned study, 12 main aspects were regarded as essential for documentation. It was hypothesised that a contributing factor to poor record-keeping was inadequate knowledge of the practitioner, of the theory and practice of spinal anaesthesia. Methods South African anaesthesia registrars (Universities of Cape Town, Free State, KwaZulu-Natal, Pretoria, Witwatersrand, Sefako Makgatho, Walter Sisulu, Stellenbosch) who are members of the South African Society of Anaesthetists (SASA) were contacted and invited to engage in an online completion of the questionnaire. A single best answer multiple choice questionnaire (20 questions) encompassing the following important aspects of documentation was utilised to assess knowledge of spinal anaesthesia for caesarean section: 1 Applied anatomy and physiology. 2 Equipment considerations. 3 Factors influencing block height. 4 Testing of the block, including management of breakthrough pain. 5 Pharmacology. Demographic details of participants were also documented. Data were transcribed from the questionnaires to an Excel spreadsheet, and coded appropriately for analysis by statistical software (MedCalc® Statistical Software version 20.218 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2023). The Shapiro-Wilk test tested for normal distribution. Subgroup comparisons within demographic 8 categories were performed using non-parametric tests (Mann-Whitney-U test for two independent samples and the Kruskal-Wallis one-way analysis of variance test for multiple independent groups). An alpha value < 0.05 was regarded as indicating statistical significance. Backward multiple linear regression analysis was performed with participant scores as the dependent variable and demographic variables as the independent variables. Backward logistic regression analysis was performed with passed/failed as the dependent variable and demographic variables as the independent variables. Results A total of 126/400 responses were received, with a response rate of 31% and margin of error 7.3%. Participants' questionnaire scores were not normally distributed. The median score was 50% (95% confidence interval (CI) 45% to 50%; range 20% to 75%). Overall, a knowledge score greater than 50% was achieved by 51.5% of registrars and 48.4% achieved lower than 50% average score. Secondary analysis showed weak associations between demographic variables and the scores achieved. Conclusions This questionnaire revealed a considerable knowledge deficit amongst anaesthesia registrars in South Africa of various aspects of the practice of SA for CS. Areas of training, including applied anatomy and physiology, equipment considerations, factors affecting block height, testing of block height and management of breakthrough pain, and pharmacology, require focused educational intervention, including simulation. This would improve documentation on the anaesthesia record and the quality of the experience of SA for CS for patients, and reduce medicolegal proceedings and ultimately patient morbidity and mortality.