Date of Award

5-2021

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Gilbert Mwaka

Second Supervisor/Advisor

Dr. Sikolia Wanyonyi

Third Supervisor/Advisor

DR. Obura Timona

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Introduction; Caesarean section is becoming increasingly common and is one of the most performed procedures globally. It is a major surgery accompanied by moderate to severe pain. Pain impacts negatively on functionality of the mother in terms of daily activities like self-care, newborn care and mobility. A post caesarean section mother therefore requires effective and safe pain relief to improve functionality, for effective breastfeeding and to reduce the risk of venous thromboembolism. Abdominal plane nerve blocks have been studied widely in the recent past and have been shown to be effective as part of multimodal post caesarean analgesia. This study is set out to find out whether nerve blocks improve post-operative functionality in post caesarean women compared to those not receiving a nerve block.

Objective; The primary aim of this study was to determine the efficacy of nerve blocks in improving post caesarean functionality in Aga Khan University Hospital Nairobi.

Methods; This was a retrospective cohort study conducted at Aga Khan University Hospital Nairobi. This is a tertiary, teaching and referral private hospital at the capital of Kenya, serving the East African community and beyond. Participants were recruited 24-36 hours post caesarean delivery between July and November 2020. A total of 205 women were recruited; 97 into the nerve blocks arm (cases) and 108 to other pain relief modalities arm (controls). A brief pain inventory-short form and a demographic tool were administered. A total functionality score of >21/70 was categorized as poor functionality whereas a score ≤21/70 was categorized as good functionality. Relative risks were computed to estimate the strength of association between exposure status -nerve blocks [cases] and other pain relief modalities[controls] and outcomes (post caesarean functionality: good vs. poor).

Results: The median functionality for all the participants was 14 (IQR 6,22) with 13 (IQR 3,21) and 14 (IQR 7.5,22) for the nerve block and other pain relief modalities respectively. The median individual functionality scores were: general activity 3 (IQR 1,5) versus 4 (IQR 2,6), walking ability 2 (IQR 1,4) versus 3 (IQR 1.5 4), relations with people 0 (IQR 0,2) versus 1 (IQR 0,2.5), sleep 1(IQR 0,3) versus 2 (IQR 0,3) and enjoyment of life 0 (IQR 0,2) versus 1 (IQR 0,2) in the nerve block and other pain relief modalities respectively. Mood and normal work had the same median scores. The median pain scores were similar in both groups. The pain at its worst had a median of 7 (IQR 5,8), pain on average 4 (IQR 3,5) among all participants. Logistic regression found that nerve block use (Adjusted RR 1.07; CI 0.910-1.264, p=0.404), age (Adjusted RR 1.01; CI 0.988-1.03, p=0.443), level of education (Adjusted RR 1.25; CI 0.953-1.650, p=0.105), opioid use ( Adjusted RR 0.97; CI 0.547-1.741, p=0.931), smoking (Adjusted RR 0.49; CI 0.160-1.471, p=0.202), one previous scar (Adjusted RR 1.16; CI 0.967-1.395, p=0.109) and two previous scars (Adjusted RR 1.09; CI 0.862-1.383, p=0.466) had no significant association with immediate post caesarean functionality. Transversus Abdominis Plane block was given to 90.2% of participants.

Conclusion; There was no difference in functionality in women receiving nerve blocks compared to those using other pain relief modalities for pain control. The overall functionality was however good in all study participants regardless of allocation.

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