Adequate analgesia in caring for paediatric burns patients in a peri-urban setting in KZN.
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Date
2020
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Abstract
This PhD thesis centres on achieving adequate analgesia in caring for paediatric burn-injured
patients in KwaZulu-Natal, South Africa. The burden of burn injuries in sub-Saharan Africa
is huge. A large number of children in the under-five age group sustain burns in the region
annually. Pain is virtually synonymous with burn injuries. All children with burns experience
pain, regardless of the cause, size or depth of the burn. This PhD study aimed to improve the
care offered to paediatric burns patients by addressing obstacles to adequate analgesia in
paediatric burns patients; and to offer a practical, easy to use, locally applicable analgesia
protocol which can be used at district, regional and tertiary hospitals alike. The objectives
were to identify deficits in the knowledge of doctors in terms of prescribing procedural
analgesia for children with burns; to evaluate the use of an alternative analgesic agent,
Methoxyflurane, for pain management during dressing changes in an outpatient department;
to compare the analgesic requirements of children presenting with acute versus chronic burns;
to evaluate the use of an alternative analgesic agent, Methoxyflurane, for pain management
during dressing changes for patients admitted to the burns ward; to evaluate obstacles to
adequate analgesia in paediatric burns patients; and to develop an analgesia protocol
applicable to KwaZulu-Natal and other low-middle-income countries (LMIC), through the
consensus of experts in the field. The development of this protocol was conducted in three
phases. The first phase involved assessing obstacles to adequate analgesia in paediatric burns
patients. The second phase involved assessing Methoxyflurane as an alternative analgesia
option in both the inpatient and the outpatient setting; and the final phase involved the
addition of Methoxyflurane to our analgesia protocols and reaching an expert consensus that
the elements included in the analgesia protocol were applicable to KwaZulu-Natal and other
low-middle-income settings. The analgesia protocol for paediatric burns patients has been
developed with the local setting and resources as a primary consideration. It was specifically
designed to be easy to use, safe in novice hands and locally applicable. In order to ensure that
theoretical findings from the study are translated into practices that benefit all burn-injured
children, this research should be combined with advocacy efforts.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.