Department of Anesthesia

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    Assessment of Knowledge, Attitude, Practice, and Associated Factors Toward Enhanced Recovery After Surgery Protocol Among Health Care Professionals: Multicenter Cross-Sectional Study
    (2025-05-01) Ermias Asefa
    Abstract Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based multidisciplinary approach designed to decrease surgical stress, enhance recovery, and improve postoperative outcomes. Despite global adoption, its implementation remains limited in our settings. Assessing healthcare professionals’ knowledge, attitudes, practices, and associated factors regarding ERAS is crucial for effective integration and better perioperative care. Objective: To assess the Knowledge, Attitudes, Practice, and associated factors of ERAS among healthcare professionals across three selected hospitals from June to October,2025. Methods: A multicenter, institutional-based, cross-sectional study was conducted across three hospitals, involving 423 participants. Data were analysed after cleaning in Excel and exported to SPSS version 26 for descriptive and inferential analysis. Chi-square and logistic regression analysis revealed factors related to Knowledge, Attitude, and Practice regarding ERAS protocols, with a significance level of p<0.05. Result: Of the expected 423 participants, 382 healthcare professionals completed the questionnaire, which yielded a 90% response rate. The prevalence of good knowledge, positive attitude, and good practice toward ERAS was 73.3% (95 % CI: 68.9%, 77.8%), 82.2% (95% CI: 78.4%, 86.0%), and 35.6% (95% CI: 30.8%, 40.4%), respectively. Factors significantly associated with outcome variables were: good knowledge included being from AHMC (AOR=2.07, 95% CI 1.07-3.98) & from GRTH (AOR=1.63,95% CI 1.67-2.96), having work experience >10 years (AOR=0.19, 95% CI 0.06-0.59) and unfamiliarity with ERAS (AOR=2.58, 95% CI 1.33-4.99), with positive attitude being nurse (AOR=3.12, 95% CI 1.97-10.05) and not familiar with ERAS (AOR=3.20, 95% CI 1.51-6.81), and with good practice being nurse (AOR=0.281,95 % CI 0.13-0.60), prior training of ERAS (AOR=0.43, 95%CI 0.20-0.95) and familiarity with ERAS (AOR=4.12,95% CI 2.08-8.47) Conclusion & Recommendations: Overall, healthcare professionals (HCPs) had good knowledge and a favourable attitude toward ERAS; however, their actual level of practice remains optimal. Integrate ERAS protocols into institutional perioperative care guidelines and provide ongoing education and training for all HCPs. Key Words: Knowledge, Attitude, Practice, ERAS, ERAS Protocol
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    Comparing the effectiveness of US-guided thoracic paravertebral block versus erector spinae plane block as postoperative analgesia in adult patients undergoing elective open upper abdominal surgery under general anesthesia at two tertiary governmental hospitals, Ethiopia, 2025 G.C. multicenter prospective cohort study
    (2025-05-01) Kelil Musa
    ABSTRACT BACKGROUND: Managing pain well after surgery is an important part of perioperative care because untreated pain can have serious effects on the body, mind, and ability to function. Ultrasonography-guided thoracic paravertebral block and erector spinae plane block have become popular for their safety and ability to help avoid opioid use. However, there is still no agreement and local evidence comparing these methods in resource-limited settings. The purpose of this study was to compare the effectiveness of ultrasound-guided thoracic paravertebral block and erector spinae plane block as pain relief methods for adult patients who had elective open upper abdominal surgery. METHODS AND MATERIALS: A multicenter prospective cohort study conducted at two tertiary hospitals in Ethiopia involved 76 adult patients who underwent scheduled open upper abdominal surgery under general anesthesia from July to October 2025 G.C. Participants were split into either the thoracic paravertebral block group or the erector spinae plane block group, based on the clinical assessment of the attending anesthetist. Data were gathered through interviews and structured questionnaires and analysed using SPSS version 26. The statistical methods utilised include chi-square or Fisher's exact test for categorical variables and Shapiro-Wilk and Levene's tests for assessing normality and variance homogeneity, respectively. Independent two-sample t-tests for group comparisons. A repeated measures ANOVA was employed to compare variations in visual analogue scale scores between groups over time. RESULTS: The postoperative visual analogue scale scores at several time points at rest or during movement were comparable at several time points, specifically at 0h, 2h, 6h, and 24h, in the ESPB group compared with the TPVB group (except at 12h, p < 0.001). The time to first rescue analgesic was significantly lower in the ESPB group compared with the TPVB group (774.1±25.73 min, 748.1±32.99 min, p<0.001). Similarly, total analgesic consumption was lower in the ESPB group (38 mg [IQR9]) compared with the TPVB (38 mg [IQR37]), with a statistically significant difference (p=0.001). The incidence of postoperative nausea and vomiting was comparable between the two groups (p>0.05). CONCLUSION: ESPB and TPVB provided comparable postoperative pain scores both at rest and during movement, except at the 12-hour mark. ESPB had a longer duration of analgesia before the first rescue analgesic and reduced total analgesic consumption within 24 hours compared with TPVB. KEYWORDS: Erector Spinae Plane Block, Postoperative Pain, Thoracic Paravertebral Block, Visual Analog Scale, Upper Abdominal Surgeries
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    COMPARISON OF POSTOPERATIVE ANALGESIA EFFECTIVENESS OF SPINAL BUPIVACAINE ALONE AND IN COMBINATION WITH TRAMADOL AND FENTANYL DURING CESAREAN DELIVERY AT ARSI UNIVERSITY TEACHING AND REFERRAL HOSPITAL. PROSPECTIVE COHORT STUDY
    (2025-05-01) DULA ABABA
    ABSTRACT Background: Cesarean section is a common obstetric procedure that is usually performed under spinal anesthesia with bupivacaine being the most commonly used local anesthetics. Adjuvants added to bupivacaine during the single shot spinal anesthesia helps in extending postoperative analgesia duration and minimize side effects. Existing studies on intrathecal tramadol and fentanyl reported conflicting results on the postoperative analgesia duration; some reported fentanyl is effective while other may support tramadol. Objective: To compare the postoperative analgesia effectiveness of spinal bupivacaine alone with that of bupivacaine combined with adjuvants tramadol and fentanyl for elective cesarean section at Arsi University Referral and Teaching Hospital from July to September, 2025. Methods: An institutional-based prospective cohort was conducted on 93 parturients. Systematic sampling technique was employed. Data was collected with chart review, intraoperative observation and postoperatively patient interview. Shapiro wilk test was used to assess normality of the data. For normally distributed, analysis of variance (ANOVA) while Kruskal Wallis test was applied for not normally distributed data. Time to event variable was analyzed by using Kaplan Meir’s survival function. P value less than 0.05 with a power 90% was considered statistically significant Results: A total of 93 parturients (31 in each group) were included in the final analysis. The duration of postoperative analgesia was significantly longer in the bupivacaine tramadol group to (420.63 ± 14.43 minutes) compared to the bupivacaine fentanyl group (283.83 ± 19.28 minutes) and the bupivacaine alone (154.07 ± 24.63 minutes), P < 0.0001. Total postoperative Analgesia consumption was significantly lower in the bupivacaine tramadol group, (p < 0.0001). The total obstetric quality of recovery score was highest in the bupivacaine tramadol group 72 (66 -81), followed by bupivacaine fentanyl group 69.5 (54 – 79) and bupivacaine alone 60 (45 -71), P < 0.0001. Conclusion: Addition of preservative free Tramadol to bupivacaine as adjuvants in spinal anesthesia for elective cesarean section increased analgesia duration, decreased 24-hour analgesia consumption, prolong time to first analgesia requests and improved obstetric quality of recovery. Key Words: Spinal anesthesia, Postoperative pain, Tramadol, Fentanyl
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    Effectiveness of Ultrasound-guided Rectus Sheath Block versus Conventional Systemic Analgesia for Pain Control and Quality of Recovery after Midline Laparotomy: A Prospective Cohort Study
    (2025-05-01) Petros Baboker
    ABSTRACT Introduction: Postoperative pain is a significant concern following laparotomy. Previous studies in Ethiopia have reported a high prevalence of moderate-to-severe pain among surgical patients. Despite advances in perioperative care, the effectiveness of the rectus sheath block remains poorly investigated in resource-limited settings. Therefore, studying the effectiveness of ultrasound-guided rectus sheath block over conventional systemic analgesia for pain control and quality of recovery is an important aspect for improving postoperative outcomes. Objective: The main aim of the study was to assess the effectiveness of ultrasound-guided rectus sheath block versus conventional systemic analgesia for pain control and quality of recovery after midline laparotomy from July 1 to September 30 /2025 Method and Materials: An institution-based prospective cohort study was conducted from July 1 to September 30/2025, by recruiting 39 patients in the rectus sheath (RSB) group and 39 patients in the conventional systemic analgesia (CSA) group using a systematic random sampling technique. The exposed group received an ultrasound-guided rectus sheath block with 40ml of 0.25% bupivacaine bilaterally, whereas the non-exposed group received routine postoperative systemic analgesia. Data cleaning and analysis were done on SPSS version 26. The Independent sample t-test and the Mann-Whitney U test were used for normally and non-normally distributed data, respectively. P-values of < 0.05 at 95% CI were considered statistically significant. Result: Patients receiving ultrasound-guided rectus sheath block reported significantly lower mean Numeric Rating Scale scores than those managed with conventional systemic analgesia during the first eight hours postoperatively (p<.05). The mean time to first rescue analgesic was prolonged among the exposed group (579 min vs. 302 min, p<.001). Twenty-four hours analgesic consumption was also significantly reduced among exposed patients (p<.001), and Quality of recovery at 24 hours was higher in the exposed group than in the non-exposed group (111.15±7.07 vs 94.03±7.15; mean difference =17.13; (95% CI: 13.92–20.34; p<.001)). Conclusion: Ultrasound-guided RSB provides superior postoperative pain control, delays the need for rescue analgesia, and enhances recovery quality in midline laparotomy. We recommend practice of Ultrasound-guided RSB as a routine post-operative pain management protocol. Key words: Rectus sheath block, Laparotomy, Pain, Recovery, Cohort
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    Effectiveness of ultrasound-guided transversus abdominis plane block vs. intrathecal morphine combined with bupivacaine for postoperative pain management in caesarean section: a prospective cohort study
    (2025-05-01) Haile Demissie
    ABSTRACT Background: Postoperative pain following caesarean section is often severe, affecting up to 93% of parturients. It influences maternal outcomes which has an impact on clinical challenge. Ultrasound-guided transverse abdominis plane block and Intrathecal morphine are widely used. However, there is ongoing debate regarding their relative effectiveness, and limited comparative evidence exists in resource-limited setting. This study provides evidence to guide practice, policy, and improve maternal recovery in resource‑limited settings. Objective: To compare effectiveness of Ultrasound-guided transverse abdominis plane block and Intrathecal morphine for postoperative analgesia in parturients undergoing caesarean section. Methods: A prospective cohort study was conducted at Asella Referral and Teaching Hospital from June 1 to September 30, 2025. Systematic random sampling was employed to select parturients undergoing cesarean section. Pain score using numerical rating score, time to first analgesia request, total analgesic consumption, and postoperative outcomes were assessed. Chi-squares, independent t-test, Mann-Whitney test, logistic regression, Linear mixed model, and survival analysis by SPSS v.25, with significance set at p<0.05. Results: 98 participants (49 per group) were included in the study. Both groups had comparable baseline characteristics (p>0.05). Postoperative pain intensity was significantly lower in parturients who received intrathecal morphine (mean difference: 0.86, p<0.001), peaked at 12 hours. It also provides superior analgesic adequacy during movement (OR: 3.65, 95% CI: 2.56-5.24, p<0.001) and a longer time to first analgesia request (median: 7 vs. 5 hours, p <0.001). Analgesic consumption and postoperative outcomes, including side effects and functional recovery, were comparable. Conclusion: Intrathecal morphine provides a lower pain score and a prolonged first analgesia request than Ultrasound-guided transverse abdominis plane block. However, both of them had relatively comparable postoperative analgesia consumption, side effects and safety profiles. Future multicenter randomized control studies are recommended to guide national practice. Key words: Intrathecal morphine, transverse abdominis plane block, cesarean section, postoperative analgesia
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    LEVEL OF PATIENT SATISFACTION WITH POSTOPERATIVE PAIN MANAGEMENT AND ASSOCIATED FACTORS AMONG ADULT ELECTIVE SURGICAL PATIENTS AT ASELLA TEACHING AND REFERRAL HOSPITAL
    (2025-05-01) NATNAEL TESFAYE
    ABSTRACT Background: Patient satisfaction with postoperative pain management reflects not only the degree of pain control but also the overall health professionals’ institutional services. Under-treated postoperative pain negatively affects patient satisfaction by altering psychological, emotional disturbances, and physical function. Understanding factors influencing patient satisfaction with postoperative pain management can help improve care outcomes and tailor pain management strategies. Although various modern pain control methods have been introduced, in Asella teaching and referral hospital, including ultrasound-guided nerve block, no studies have been conducted in this study area. Objectives: Assess the Level of patient satisfaction with postoperative pain management and its associated factors among adult elective surgical patients at Asella Teaching and Referral Hospital from July to September /2025 Method: - An institution-based cross-sectional study was conducted among 135 adult elective surgical patients by using a systematic random sampling technique. Data were collected using modified APS-POQ-R structured questionnaires, interviews, and Chart records in the KoboToolbox. The data was checked, downloaded, and then transferred to SPSS version 26 for analysis. Bivariate and Multivariate Binary logistic regression were used to identify associated factors. A p-value less than 0.05 was considered statistically significant. The study's findings were reported and presented in text, tables, graphs, and charts. Result: The findings of this study revealed that 114(84.4%) of patients were satisfied with postoperative pain management services. Patients who received multimodal analgesics with nerve blocks (AOR = 2.43; 95%CI: (1.39-8.45)) were associated with a high level of satisfaction. Patients who experienced moderate interference of sleep (AOR 0.45; 95% CI: (0.21-0.96)) were associated with lower satisfaction with postoperative pain management. Conclusion and recommendation: Our study showed that multimodal analgesia with PNB and the sleep interference from untreated acute postoperative pain were essential factors related to overall patient satisfaction. We recommend that all health professionals routinely follow, assess, and promptly provide multimodal analgesia to surgical patients to manage acute postoperative pain adequately. Keywords: Postoperative Pain, Patient Satisfaction, Elective Surgery