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A Comparison of Pain Scores with Or Without Local Anaesthesia in Neonatal Circmcision Using Plastibell Technique at Plateau Stat

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A Comparison of Pain Scores with Or Without Local Anaesthesia in Neonatal Circmcision Using Plastibell Technique at Plateau Stat A COMPARISON OF PAIN SCORES WITH OR WITHOUT LOCAL ANAESTHESIA IN NEONATAL CIRCMCISION USING PLASTIBELL TECHNIQUE AT PLATEAU STATE SPECIALIST HOSPITAL, JOS, NIGERIA A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF THE COLLEGE IN FAMILY MEDICINE (FMCFM) PART II FINAL EXAMINATION MAY 2010 BY DR.AMINU GANGO FIKIN DEPARTMENT OF FAMILY MEDICINE PLATEAU STATE SPECIALIST HOSPITAL, JOS, NIGERIA i ACKNOWLEDGEMENT My heartfelt gratitude goes to DR STEPHEN YOHANNA for his ingenuity, thorough supervision, guidance and encouragement throughout the entire period of my training and this work. I’m also grateful to DR PITMANG, DR LAR, DR LAABES, and DR INYANG for their contribution and criticism. My gratitude goes to all the consultants of Plateau State Specialist Hospital, Jos for contributing in one way or the other during my period of training. My sincere thanks goes to DR ABUBAKAR BALLA who provided me with shelter throughout the period of my training. ii DEDICATION To my children, AHMED, YUSUF, HADIJA, ALHAJI GONI, BA MAINA, AWULU and ABDULMUMINI, my wife, MOGOROM FATI MAINA GORIA, and my Mother and Father. Thank you for everything you are to me. iii CERTIFICATION This is to certify that Dr. Aminu G. FIKIN performed the study reported in this Dissertation at Plateau State Specialist Hospital under our supervision. We also supervised the writing of the dissertation. SUPERVISOR Dr. STEPHEN YOHANNA (BM, BCH; MPH; FMCGP; FWACP) CONSULTANT FAMILY PHYSICIAN EVANGEL HOSPITAL, JOS, NIGERIA SIGNATURE: ………………………………………………….. DATE: …………………………………………………………. HEAD OF DEPARTMENT Dr. INYANG OLUBUKUNOLA (MB, BS; FMCGP) CONSULTANT FAMILY PHYSICIAN PLATEAU STATE SPECIALIST HOSPITAL, JOS, NIGERIA SIGNATURE: …………………………………………. DATE: ……………………………………………………….. iv LIST OF ABBREVIATIONS AAP American Academy of Pediatrics AMA American Medical Association BC Before Christ CRIES Crying, Requirement, Increased vital signs, facial Expression and Sleeplessness FLACC F ace, Legs, Activity, Cry, and Consolability IASP International Association for Study of Pain NFCS Neonatal Facial Coding System NIPS Neonatal/Infant Pain Score N-PASS Neonatal Pain Agitation and Sedation Scores PIPP PREMATURE Infant Pain Profile US United States WHO World Health Organization v TABLE OF CONTENTS ACKNOWLEDGEMENT ........................................................................................................................... i DEDICATION .......................................................................................................................................... ii CERTIFICATION ..................................................................................................................................... iii LIST OF ABBREVIATIONS .................................................................................................................... iv TABLE OF CONTENTS ........................................................................................................................... v LIST OF TABLES .................................................................................................................................. viii LIST OF FIGURES ................................................................................................................................. ix ABSTRACT ............................................................................................................................................. 1 CHAPTER ONE: INTRODUCTION ......................................................................................................... 3 1.1 INTRODUCTION ............................................................................................................................... 3 1.2 STATEMENT OF THE PROBLEM AND PROBLEM ANALYSIS. .................................................... 6 1.3 AIM .................................................................................................................................................... 6 1.4 OBJECTIVES .................................................................................................................................... 6 1.5 RATIONALE FOR THE STUDY......................................................................................................... 7 1.6 RELEVANCE OF THE STUDY TO FAMILY MEDICINE. ................................................................ 7 CHAPTER TWO: LITERATURE REVIEW ............................................................................................... 9 2.1 HISTORY OF CIRCUMCISION. ........................................................................................................ 9 2.2 EPIDEMIOLOGY OF CIRCUMCISION. ........................................................................................... 14 2.3 CIRCUMCISION TECHNIQUES. ..................................................................................................... 19 2.4 NEONATAL PAIN RESPONSE DURING CIRCUMCISION. ............................................................ 24 vi 2.5 PAIN ASSESSMENT TOOLS. ......................................................................................................... 32 2.6 PAIN MANAGEMENT IN NEONATES. ......................................................................................... 37 2.7 ANAESTHESIA FOR NEONATAL CIRCUMCISION. ...................................................................... 44 2.8 COMPLICATIONS OF NEONATAL CIRCUMCISION. .................................................................... 47 CHAPTER THREE: MATERIALS AND METHODS .............................................................................. 59 3.1 STUDY ENVIRONMENT. ................................................................................................................ 59 3.2. STUDY POPULATION. .................................................................................................................. 59 3.3 STUDY DESIGN. ............................................................................................................................. 59 3.4 THE SAMPLE SIZE. ........................................................................................................................ 60 3.5 SAMPLING METHOD. ..................................................................................................................... 60 3.6 INCLUSION CRITERIA. .................................................................................................................. 61 3.7 EXCLUSION CRITERIA. ................................................................................................................. 61 3.8 METHOD AND INSTRUMENT OF DATA COLLECTION. ............................................................... 61 3.9 METHOD OF DATA ANALYSIS. ..................................................................................................... 65 3.10 ETHICAL CONSIDERATION. ........................................................................................................ 65 CHAPTER FOUR: RESULTS. ............................................................................................................... 66 4.1 PHYSICAL CHARACTERISTICS OF THE NEONATES.................................................................. 66 4.2 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE PARENTS. ............................................. 67 4.3 NEONATAL INFANT PAIN SCORES. ............................................................................................. 68 4.4 COMPARISON OF MEAN NEONATAL INFANT PAIN SCORES. .................................................. 70 4.5 PHYSIOLOGICAL CHANGES DURING CIRUMCISION. ................................................................ 74 4.6 DURATION OF CIRCUMCISION .................................................................................................... 76 vii 4.7 COMPLICATIONS OF NEONATAL CIRCUMCISION ..................................................................... 77 4.8 REASONS FOR CIRCUMCISION. .................................................................................................. 79 CHAPTER FIVE: DISCUSSION ........................................................................................................... 80 5.1 PHYSICAL CHARACTERISTICS OF NEONATES .......................................................................... 80 5.2 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE PARENTS. ............................................. 81 5.3 NEONATAL INFANT PAIN SCORES .............................................................................................. 82 5.4 PHYSIOLOGICAL AND BEHAVIOURAL CHARACTERISTICS ...................................................... 84 5.5 COMPLICATIONS OF NEONATAL CIRCUMCISION ..................................................................... 86 5.6 DURATION OF SURGERY ............................................................................................................. 87 5.7 REASONS FOR NEONATAL CIRCUMCISION ............................................................................... 87 5.8 IMPLICATIONS FOR FAMILY PHYSICIANS .................................................................................. 88 5.9 CONCLUSION ................................................................................................................................. 89 5.10 RECOMMENTATION. ..................................................................................................................
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