The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital.
A prospective study was conducted in the Department of Anesthesiology and Intensive Care at ...the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery.
The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively.
Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.
To describe perioperative critical incidents, the conduct of anaesthesia and perioperative mortality in elective paediatric surgery patients in a national referral hospital in Niger. This is a ...prospective, observational study conducted from January to March 2018. All paediatric patients 15 years and younger, who underwent elective surgery in the Niamey National Hospital were included. The following variables were studied: age, sex, type of surgery, American Society of Anesthesiologists physical status (ASA PS) classification, monitoring system, anaesthesia technique, critical incidents, blood transfusion, analgesia, qualification of the anaesthesia practitioner, postoperative destination and mortality. Data were analysed with Excel 2007 and Epi Info 6™ (Centers for Disease Control and Prevention Atlanta, GA). The chi2 test was used for univariate associations with critical incidents. Statistical significance was considered if p<0.05. There were 231 (27.2%) paediatric patients of 849 surgical patients during the study period. Within the paediatric group, the mean age was 6 ± 4 years. The male:female sex ratio was 1.65. A full blood count was completed preoperatively in all patients. Three per cent of the patients received a preoperative blood transfusion. The most frequently performed surgery was abdominal (42.4%). Most patients were classified as ASA PS I (55%) and ASA PS II (45%). General anaesthesia was performed in 96.1% of cases and spinal anaesthesia in 3.9%. The median duration of general anaesthesia was 63 (interquartile range 45–90) minutes. There were 27 reported critical incidents (11.7%), ten of which occurred during induction (4.9%), five intraoperatively (2.2%) and 12 postoperatively (5.2%). Multimodal postoperative analgesia was used in 33.8% of these patients. One patient died in the postoperative period (0.43%).Perioperative critical incidents in paediatric surgical patients in Niger remain high. To improve this situation requires paediatric training of anaesthetic staff, and improved paediatric monitoring and the use of safer anaesthesia agents.
Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in ...Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included âge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality.
Introduction: The aim of this work was to highlight the therapeutic and prognostic difficulties between a laparoscopic cholecystectomy for acute gallstone cholecystitis (CAL) and uncomplicated ...symptomatic vesicular lithiasis (LVS) as well as the reasons for conversion to laparotomy. Patients and Methods: This was a prospective comparative and analytic study over 18 months. Patients admitted and operated for CAL or LVS in the A Surgery Department of the National Hospital of Niamey (HNN) were included. Results: The study involved 61 patients divided into two groups. Group 1 (30 patients) corresponding to patients operated for CAL, group 2 (31 patients) corresponding to patients operated for LVS. Laparoscopic cholecystectomy accounted for 61% of all cholecystectomies performed and 1.45% of surgical activity during the same period. The average age in group 1 was 43.7 years with extremes of 14 and 61 years. In group 2, the average age was 38.9 years with extremes ranging from 12 to 55 years. Women were predominantly represented with 63.3% and 96.7% respectively for groups 1 and 2. Patients were overweight in 9 cases for group 1 (30% of cases) and 12 cases in group 2 (38%), 7% of cases). Hepatic colic was the main sign of appeal in all patients in both groups. In group 1; 26 out of 30 cases or 86.7% of cases had leukocytosis, whereas in group 2, leukocytosis was normal in 30 cases, ie 96.8% of cases. Accessibility of the vesicle was difficult in 73.3% of cases in group 1 against 22.6% of cases in group 2. The vesicle was distended and necrotic in groups 1 in 76.7% and 10 respectively. % of cases. On the other hand, in 25.8% of cases, the vesicle was distended and without any necrosis in group 2. The rate of conversion to laparotomy was 6.55% (4 cases) and exclusively concerned group 1. Operative follow-up immediate outcomes were simple in 98.34% of cases. The complications involved 2 patients in group 1 (1.66% of the total), including parietal suppuration and biliary leakage. Mean operative time was 68.7 min in group 1 versus 41.6 min in group 2. Mean duration of hospitalization was 4.3 days with extremes between 2 and 10 days in group 1 versus1,7 days with extremes ranging from 1 to 7 days in group 2. Mortality was zero. Conclusion: In recent years, laparoscopic surgery has made remarkable progress in Niger. Laparoscopic cholecystectomy seems to be more difficult to perform with significant morbidity in the case of CAL than LVS. The risk of per and postoperative complications can be estimated from the clinical data (acute cholecystitis or symptomatic vesicular lithiasis) and the surgeon's experience. In a cholecystectomy that lasts more than 2 hours, the cumulative risk of complications is higher
Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of ...this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases.
Introduction: Acute intussusception is a rare clinical entity in adults where it accounts for only 1-2% of intestinal obstructions. The authors wanted to report cases of acute intussusception in ...adult patients, their diagnostic aspects, their management, and their etiologies. Patients and Methods: This study is a retrospective study of the medical files of patients of both sexes. They include adults over 15 years of age, operated between January 2010 and December 2014, who were diagnosed with obstruction due to acute intestinal intussusception. Results: Six cases of adult intestinal intussusception were collected. The average age was 26.5 years. The sex ratio was 1 and there were so many men as women. Five out of six patients were unstable on admission. The diagnosis was made preoperative in two cases out of six, 33.3%. Ultrasound revealed a target sign in two cases. The ileo-ileal form was the most frequent (5 cases out of 6) or 83.3%. Also, there were two cases of intestinal necrosis out of six. Intestinal resection was performed in five cases or 83.33%. The cause of intussusception was found in four cases out of six or 66.7%. Here, a tumor was the cause in half of the cases. Immediate surgical follow-up was uncomplicated in all patients. Conclusion: Acute intestinal intussusception of the adult is a very rare condition. The preoperative diagnosis of acute intussusception of the adult remains delicate. The ileo-ileal form is more frequent than the ileo-colic form in adults. Treatment is always surgical in adults.
Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to ...complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high.
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