Masters Degrees (DS) Medicine

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A comparative study of analgesic effect of caudal bupivacaine with dexmedetomidine versus bupivacaine alone for infraumbilical surgeries in children in Windhoek Central Hospital
(University of Namibia, 2025) Amaambo, Niita Nelago Tangi; Roche, Tony
Background: Paediatric pain is frequently underassessed and undertreated due to challenges in pain expression among children, which can result in its under recognition. Untreated pain can potentially lead to long-term consequences on children's emotional and psychological welfare. The use of caudal blocks has evolved to become the most common regional anaesthesia technique for providing intraoperative and postoperative analgesia in children undergoing infraumbilical surgeries. Existing literature has demonstrated that caudal administration with bupivacaine alone typically has a short duration of action, and its analgesic effect can be prolonged by incorporating adjuvants such as dexmedetomidine. The overall objective of this study is to compare the difference in the duration of analgesic effect between caudal bupivacaine alone and bupivacaine with dexmedetomidine by using first time request of ibuprofen syrup based on the modified Hannallah pain score of ≥ 4. Methodology: This was a prospective randomised double-blinded control study and data were collected over a period of five months. The study included children scheduled for elective infra-umbilical surgeries. A total of 50 children, aged 1 – 8 years were recruited and divided into two groups (A and B) of 25 children each. Group A received caudal block with 0.25% bupivacaine at a dose of 0.5 or 1 ml/kg. Group B received 0.25% bupivacaine caudal bupivacaine at a dose of 0.5 or 1 ml/kg with dexmedetomidine (1mcg/kg). Patients were monitored for 24 hours and data were collected using a research questionnaire designed for the study. The data were analysed using SPSS for Windows, version 26.0. (IBM Corporation, Armonk, NY, USA). Results: For Group A patients, the mean time to first request for rescue ibuprofen was 471±230 minutes. In contrast, Group B patients had a mean of 1339±210 minutes. These differences were statistically significant. Total consumption of ibuprofen syrup was 298.00±150.665 milligrams in Group A and 53.20±82.952 milligrams in Group B, the difference was statistically significant. No significant difference was observed between the two groups in the incidence of pain scores, haemodynamic parameters and side effects. Conclusion: The addition of dexmedetomidine significantly extended the duration of analgesia provided by caudal bupivacaine in paediatric patients undergoing infraumbilical surgeries without an increase in the incidence of haemodynamic changes and side effects
A comparison of spinal anaesthesia with and without transversus abdominis plane block in patients undergoing elective caesarean section at Windhoek Hospital Complex
(University of Namibia, 2025) Kakololo, Tonata Si; Jenkins, Brian
Background: Pain is a known outcome complication of surgery in the post-operative period, especially after Caesarean section. Lack of pain relief postoperatively also poses great risks for patients’ health. The combination of Transversus Abdominis Plane (TAP) block with spinal anaesthesia is emerging as a superior approach for managing postoperative pain, particularly in abdominal surgeries. While spinal anaesthesia provides effective lower body analgesia, it can result in inadequate pain control and side effects like hypotension. TAP block enhances pain relief without the adverse effects associated with spinal anaesthesia. Overall, the integration of TAP block with spinal anaesthesia offers significant advantages in pain management strategies. Aim: The main objective of this study was to compare the benefit of adding transversus abdominis plane (TAP) block to spinal anaesthesia versus spinal anaesthesia alone in patients undergoing elective Caesarean section. Setting and Design: This was a randomised single-blinded control study conducted over a period of six months in the maternity theatres of Windhoek Central Hospital and Intermediate Hospital, Katutura. Methods and Materials: The effect size on pain scores was determined to be the magnitude of the difference between groups, according to a study by Cohen et al. A medium effect size of 0.5, an alpha error of 0.05, and a power of 80% were used to calculate the number of patients required in each group. The result was 64 patients per group. Assuming an average attrition rate of 11% quoted in a similar study, this suggested that 72 patients were required per group so that in total, the study sample size constituted 144 patients. Patients planned for elective caesarean section were randomly allocated to two groups, A and B. Group A received spinal anaesthesia only with 0.5% heavy bupivacaine 9 mg (1.8 ml) and fentanyl 15 mcg. Group B received spinal anaesthesia and TAP block using 40 ml plain bupivacaine 0.25%. (with the same drug doses as in Group A). The analgesic efficacy spinal anaesthesia alone and spinal anaesthesia combined with TAP block was compared over various time intervals (2, 4, 6, 12, and 24 hours postoperatively) both at rest and movement. Statistical Analysis: Numbers with percentages were used to represent nominal variables, while continuous variables were summarized in terms of mean ± SD or median and interquartile range, as appropriate. A statistician examined the distribution of the data before iii using the Student's T-test to compare the results from the study groups. When appropriate, the Z score for a two-population proportion was applied. Statistical significance was defined as a P-value of less than 0.05. Results: At both rest and movement, spinal anaesthesia alone consistently showed higher pain scores compared to TAP block across all time intervals. Statistically significant differences were observed with p value of (p= <0.001), except for the 2-hour mark at rest where no significant difference of between the two groups was observed (p=0.97). Conclusion: This study highlights the effectiveness of TAP block as an adjunct to spinal anaesthesia in managing postoperative pain following Caesarean section. Patients who received both spinal anaesthesia and TAP block reported higher levels of satisfaction with their pain relief, compared to those who received spinal anaesthesia alone. These findings underscore the potential benefit of incorporating TAP block into multimodal analgesic approaches to enhance postoperative pain management and patient satisfaction
A comparison of intrathecal morphine or fentanyl on the duration of postoperative analgesia at Namibian teaching hospitals in Windhoek
(University of Namibia, 2022) Murakwani, Mandiudza Maria
Background: Pain management is a cornerstone in the management of femoral fractures. Poorly controlled perioperative pain is associated with detrimental short-term and long-term effects. Addition of intrathecal opioids has been shown to produce a dense block and enhance analgesic effect. The objective of the study was to compare the duration of postoperative analgesia of intrathecal morphine or fentanyl for femur fracture surgery at Namibian Teaching Hospitals in Windhoek. Methodology: This was a prospective randomised double blinded control study which was done in February – July 2021; in which 60 patients above 18 years scheduled for femur fracture surgeries received standard spinal anaesthesia with 0.5% heavy bupivacaine 12.5 mg plus 100 mcg morphine (ITM group) or 25 mcg fentanyl (ITF group). Data was collected using a form designed for the study and analysed with the statistical package for social sciences (SPSS for windows 26.0, SPSS Inc., Chicago, IL, USA). Results: Participants in the ITM group had a significantly longer time to first request for analgesic (14.5 ±8.03 hours) versus the ITF group (7.07 ± 3.07 hours), p =0.0001 and reduced total opioid consumption in 24 hours. The postoperative pain scores (verbal numerical rating scale) at rest and with movement were significantly lower in 2nd, 4th and 6th hour in the ITM group compared to the ITF group (p <0.05). No significant difference was observed between the two groups in terms of pruritus, nausea and vomiting. Respiratory depression was not observed in any participant in the two groups. Patient satisfaction with analgesia was superior in the ITM group (p =0.0001). No significant association was confirmed between type of femur fracture and the total opioid consumption in 24 hours. Conclusion: Use of intrathecal morphine significantly increased the duration of postoperative analgesia and reduced the total opioid consumption.
Evaluation of the effect of 2.5 IU vs 5 IU oxytocin on uterine tone during elective caesarean section at Windhoek hospital complex: A double-blind randomized controlled clinical study
(University of Namibia, 2022) Nembale, Fredrika Nembale
Introduction: Oxytocin is routinely administered during caesarean delivery to initiate and maintain uterine tone (UT) after delivery of the baby. It reduces blood loss thus preventing postpartum haemorrhage (PPH). However higher doses of oxytocin are associated with unwanted side effects namely; cardiovascular effects, headache as well as nausea and vomiting. However, the optimal dose of oxytocin at caesarean delivery remains ambiguous among various official bodies. This study compared the effect of two doses of oxytocin 2.5 IU vs 5 IU on uterine tone, haemodynamic changes, blood loss and side effects. Methodology: A double-blinded, randomized controlled clinical study was conducted at Windhoek Teaching Hospitals Complex. Eighty (80) parturients undergoing elective caesarean section under spinal anaesthesia received an intravenous bolus of either 2.5 IU (n=40) or 5 IU (n=40) of oxytocin after delivery followed by an infusion of 5 IU/hr. Uterine tone, haemodynamic changes, side effects and blood loss were compared between the two groups. The two groups were statistically compared using a two-sided, independent samples t-test with a P-value set at 0.05 (5%) critical level of significance using the per-protocol analysis. Results: The two groups were comparable in terms of demographic characteristics. Parturients in both study groups had adequate uterine tone at 3 minutes with a median (SD) score of 3.28(0.51) for the 2.5 IU group and 3.20(0.56) for the 5 IU group. A rapid increase in heart rate (HR) was seen in the 5 IU group with a mean increase of 17(17) and 12(16) beats/min at 1 min and 2 min with a p-value of 0.000 and 0.005 respectively. Higher incidence of nausea, headache and chest pain (40%, 25%, 15%) were noted in the ii 5 IU group compared to (15%, 2.5%, 0%) in the 2.5 group. Blood loss did not differ among the two groups. Conclusion: 2.5 IU of oxytocin bolus was compared and non-inferior to 5 IU oxytocin bolus in initiating and maintaining adequate uterine tone and it was associated with fewer haemodynamic changes and other adverse effects.
Evaluation of the effect of parental presence on anxiety among paediatric patients during induction of general anaesthesia at Intermediate Hospital Oshakati: A cross-sectional quasi experimental trial
(University of Namibia, 2025) Iyambo, Fenni Megameno; Morgan, Judith
Introduction: Parental presence reduces children’s anxiety, improve the anaesthetic induction and has been shown to increase parental satisfaction This study investigated the impact of parental presence on preoperative anxiety and cooperation among paediatric patients undergoing general anaesthesia induction. Methodology: A cross-sectional quasi-experimental trial was conducted at Intermediate Hospital Oshakati, involving 104 pediatric patients aged 2 to 10 years undergoing elective minor and major operations. Anxiety levels were assessed using the Modified YALE Preoperative Anxiety Score (mYPAS) in both the waiting area and theatre, while induction compliance was measured using the Induction Compliance Checklist (ICC). Statistical analysis included Welch's t-test and Chi Square Test, with a critical significance level of 0.05. Results: Results indicated that parental presence during induction significantly improved pediatric cooperation (p<0.001) and reduced anxiety levels in the theatre (p < 0.001. Moreover, notable differences in anxiety levels and compliance were observed between different age groups. Younger children (2 to 5 years) displayed higher anxiety levels in the theatre compared to older children (6 to 10 years) with P value 0.004. Interestingly, no significant differences in anxiety levels or compliance were found between patients undergoing minor and major surgeries. Conclusion: The study underscores the significance of considering both parental presence and age when managing anxiety and promoting cooperation in pediatric patients undergoing inhalational induction. Age also plays a role, with younger children experiencing higher theatre anxiety. Recommendations: The findings suggest promoting parental presence, developing age-specific strategies, and providing pre-operative education to alleviate anxiety and enhance cooperation among pediatric patients
Frequency and factors associated with cancellation of elective surgical operations in Intermediate Hospital Oshakati
(University of Namibia, 2025) Ndeshipanda, Josef Sakeus; Nweze, Onochie
Introduction: An elective surgical case cancellation refers to any planned operation that was not performed on the scheduled day. This problem has a negative impact on health systems, especially in resource challenged countries. This study determined frequency and factors associated with cancellation of elective surgical operation in Intermediate Hospital, Oshakati. Methodology: A prospective observational cohort study design was employed. All patients scheduled to undergo elective surgeries from September to November 2023 were recruited. A proforma was used to extract data from patient’s record, daily scheduled operation lists and theatre surgery register. A thematic analysis of reasons for cancellation was employed. Furthermore, analysis included descriptive statistics as frequencies and percentages, presented in tables. Results: During the study period, 1599 elective surgeries were booked, of which 336 cases (21%) were cancelled on the day of surgery. Of the total cancelled cases, 186 (55.4%) were female and 150 (44.6%) were males patients. Vascular surgery (45.8%) had the highest proportion of cancellations while Ear, Nose and Throat (ENT) department had the least (9.4%). The most common factors why surgeries were cancelled were time constraints (21.4%) and lack of theatre space (15.5%). Conclusion: The overall cancellation incidence was found to be higher than the internationally recommended rate of less than 5%. Our 21% rate was found higher than that of most developed countries but lower than some African countries. Resource limitations related factors constituted the most common category of reasons for cancellations. Recommendation: Most causes of cancellation can be avoided by building more theatre space, employ more staffs and prioritizing the optimal functioning of operating theatre in the hospital. Development of operating theatre standard of practice and policies is of equally important. Furthermore, a constant communication between theatre user parties should me maintained
Perioperative medication errors among anaesthesia service providers in Namibia - A retrospective survey
(University of Namibia, 2025) Oyinbo, O.M.; Rukewe, Ambrose
Medication administration errors are widespread across the healthcare system resulting in huge human and financial costs. Notably, drug administration errors are a major reason for malpractice claim against anaesthesia service providers. The outcomes of medication errors range from no harm and to the grievous events such as intensive care admissions or death, nonetheless they are preventable. The study was aimed to determine the prevalence and characteristics of the common perioperative medication administration errors among anaesthesia service providers in Namibia, identify the contributing factors and assess their outcomes on patients. METHODOLOGY This was a descriptive, retrospective survey among specialist anaesthesiologists, anaesthesia registrars and medical officers across the 34 public hospitals and 18 private hospitals in Namibia over a period of one month. A confidential, self administered structured questionnaire was shared with participants via the email, phone and as a web-based survey. RESULTS Out of 122 questionnaires shared, 112 (92%) anaesthesia providers responded. There were slightly more female participants, 58 (52%) than males and mostly medical officers (56%). Among the respondents, 88 (79%) indicated that they had committed one or more medication errors during their anaesthesia practice. The commonest type was omission (46%), followed by the administration of a wrong drug (27%). In 69% cases, there was no harm to the patients while 6% had HDU/ICU admissions and 1 (0.9%) died. CONCLUSION This index study found a high prevalence of medication administration errors among the practitioners, comparable with many studies. Majority of patients did not suffer any harm. Most respondents blamed the occurrence of errors on distractions/fatigue. It is important to increase awareness and training for prevention as well as set up a nationally coordinated incident reporting system for perioperative drug administration errors in Namibia
Prophylactic phenylephrine bolus versus infusion for prevention of maternal hypotension during spinal anaesthesia for caesarean section at Windhoek-based teaching hospitals, Namibia
(University of Namibia, 2022) Shaanika, Ebba Panduleni
Background: Maternal hypotension is a common complication of spinal anaesthesia during caesarean delivery. Injection of vasopressors with non-pharmacological measures have been investigated for prevention of martenal hypotension as well as the foeto-maternal effects of treatment. Aim: The primary aim of the study was to compare prophylactic 50 mcg phenylephrine bolus (PB) with a fixed continuous 25 mcg/min phenylephrine infusion (PI). The secondary aim was to assess the side effects and neonatal outcomes of the two treatments. Settings and design: A prospective, randomised, controlled double-blinded study was conducted in the maternity theatres of Windhoek Central Hospital and Katutura Intermediate Hospital. Methods and Materials: Ninety-two eligible parturients, ASA I and II, scheduled for elective caesarean section under spinal anaesthesia were recruited and randomised into two groups. PB group received a prophylactic 50 mcg phenylephrine (PE) bolus immediately after spinal anaesthesia whereas PI group received prophylactic 25 mcg/min PE infusion. Maternal blood pressure, heart rate and side effects were recorded every minute for the first 20 minutes while neonatal outcome was assessed with Apgar score at the 1st and 5th minute. Statistical Analysis: Categorical variables were presented in numbers and percentages. Normally distributed continuous variables were presented as mean standard deviation (±SD) and compared using t-test. Non normally distributed continuous variables were compared with Mann-Whitney test. A p-value of p< 0.05 was considered significant. Results: Parturients in the PI group had a significantly lower incidence of hypotension than PB group (32% vs 71% p = 0.0001). Nausea and vomiting was lower in PI group than PB group (13% vs 31% p = 0.033). Reflex bradycardia was comparable between groups (p= 0.489). No parturient in the PB group had reactive hypertension whereas 11% of participants in PI group did (p=0.024). Participants in the PI group received about 36% more phenylephrine than the PB group (p=0. 0277). Apgar scores between the two groups showed good neonatal outcomes. Conclusion: There was better control of blood pressure in the PI group than PB group. Both groups had similar incidence of reflex bradycardia as well as good neonatal outcomes. Intraoperative nausea and vomiting (IONV) was higher in the PB group than PI group, whereas no reactive hypertension experienced in PB group.
A survey on end of life care practices in intensive care units of three government teaching hospitals in Namibia
(University of Namibia, 2022) Shivolo, Loini Talishi
Background: End of life (EOL) care may be described as care provided for patients in the final hours or days of their life. More broadly it’s defined as care for all patients with a terminal illness that is deemed progressive and incurable. It implies a focus on pain and symptom management which is distinct from the aggressive pursuit of investigation and therapies focused on cure. End of life care in the ICU however involves a substantial degree of emotional and psychological stress both for health care providers as well as the family members. Significance of the study: The study aimed to evaluate the current practices of EOL care in a lifesaving department like the intensive care unit. It also intended to evaluate the knowledge of EOL care practices among ICU health professions and to identify gaps that would require improvement. Methodology: This was a mixed study that used the sequential explanatory design. It had a quantitative study phase 1 and a qualitative study phase 2. The quantitative method looked at the experience of health care workers on EOL care as the dependent variable with relation to age, training background, gender, and years of employment and facility of employment. The qualitative method approach was used to assess the knowledge and attitudes of family members and health care providers on EOL care. This methodology was achieved through cross-sectional surveys and a series of questionnaire-based interviews. Findings: About 59.7% of the respondents had never heard the term EOL care. In addition, less than half of them reported that the decision to offer EOL care to patients rested with the attending physicians. Furthermore, 50% of the study participants believed that family members do not take part in the decision to offer their patients EOL care. Conclusion: EOL is an essential part of patient management. Not only for the patient but also focuses on family members and health care workers as it has an effect on their emotional, mental health, as well as physical health. Recommendations: Improve communication between health care workers and family members and continuous medical education to be offered to health care workers on EOL care.

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