Abstract A32: Postoperative analgesia in a Ugandan population
Authors: Maskal Sara , Patel Nilam , Cabrera Claudia , Tamaki Akina , Kabagenyi Fiona , Bwete Ian , Mukiibi Isaac , Kabazzi Edrisa , Harrill Katrina , Otiti Jeffrey , Thuener Jason , Zender Chad 
Published: September 2020

Abstract
Introduction: Opioid dependence is a major problem in the Western world. There have been significant efforts seeking to optimize pain control pathways and minimize risk of dependence on opioid pain relievers. However, little is known in low- to middle-income countries regarding current practices in postoperative pain control and its efficacy. This study evaluates subjective pain scores of patients following head and neck surgeries in a Ugandan hospital. These patients are unique in that most are opioid naive. We hope to contribute to the understanding of adequate postoperative pain control in opioid naive patients.
Methods: Twenty-five patients without chronic opioid use underwent head and neck surgery during a semiannual surgical outreach trip. Ages ranged from 4-77 years (mean 38). The most common procedures performed were hemithyroidectomy (5), total thyroidectomy (3), parotidectomy (3), tonsillectomy (2), and cystic hygroma removal (2). Charts were reviewed retrospectively for daily subjective pain scores assessed on a numerical scale of 0-5, length of hospital stay, postoperative medications given for pain, surgery type, and postoperative analgesic medications administered, including dosage and frequency. Wilcoxon analysis was used to compare medians between groups receiving paracetamol alone or in combination with opioids or other analgesics.
Results: All patients received IV paracetamol postoperatively; 16% of patients also requested opioids, and 8% requested another nonopioid analgesic. Average age for the 6 patients receiving paracetamol and either opioids or another nonopioid analgesic was 49.17 years compared to 34.47 years in the group that received paracetamol only (p=0.26; 95% CI -12.5, 42.9). For the whole study population, there was a reduction in the median pain score of -1.9 points (p&lt;0.005; 95% CI -2.5, -1.01). Patients who received only paracetamol showed a reduction in median pain score from 3 to 2 (p&lt;0.05; 95% CI (1.01 - 2.5)) compared to a reduction from 2.5 to 2 (p=0.37) in patients who received paracetamol and any another class of analgesic. Individually the group of patients who received paracetamol and opioids reported a reduction in the median pain score from 3 to 2.5 (p=1), and the group of patients who received paracetamol and another nonopioid analgesic reported a reduction in median pain score from 1.5 to 1 (p=1).
Conclusion: Despite language and cultural barriers, we were able to assess postoperative pain scores in a Ugandan population. Intravenous paracetamol alone was effective and adequate for postoperative pain management for the majority of patients in this study. Although this study was limited in sample size, there was no significant improvement observed in pain score for patients using opioids or nonopioid analgesics other than paracetamol compared to paracetamol only. Opioids or additional analgesics were requested by a minority of patients, who tended to be older and/or have undergone more extensive procedures.
Citation Format: Sara Maskal, Nilam Patel, Claudia Cabrera, Akina Tamaki, Fiona Kabagenyi, Ian Bwete, Isaac Mukiibi, Edrisa Kabazzi, Katrina Harrill, Jeffrey Otiti, Jason Thuener, Chad Zender. Postoperative analgesia in a Ugandan population [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A32.