Post-Caesarean analgesia in Timor-Leste, a low-middle-income country

摘要

Timor-Leste is a small, low-middle-income country in Southeast Asia. It is reported to spend less on healthcare than any other?country.~(1) Hospital Nacional Guido Valadares performs 6 000?deliveries a year. Epidural analgesia, intrathecal opiates, transversus abdominis plane blocks, oral and intravenous opiates, and non-steroidal anti-inflammatory agents have all?been mooted as techniques useful in improving post-caesarean?analgesia.~(2,3) Most of these options are unavailable in Timor-Leste.?Opiate use in theatre is minimal and opiates are unavailable on?the ward. Epidural anaesthesia and patient controlled analgesia?are unavailable. A locally formulated post-caesarean pain?management protocol, taking into account available agents?and expertise, encourages spinal anaesthesia with hyperbaric bupivacaine followed by 100 mg intramuscular tramadol in the?recovery area, followed by oral paracetamol 1 gm qid., tramadol?50 mg qid. and ibuprofen 400 mg tds. in the wards. This study sought to determine the efficacy of this protocol in a low resource environment.