Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190004
Brazilian Journal of Pain
Original Article

Knowledge, attitude and practice regarding pharmacological methods of labor analgesia

Conhecimento, atitude e prática em relação aos métodos farmacológicos de analgesia de parto

Bianca Ruschel Hillmann; Ana Maria Nunes de Faria Stamm

http://dx.doi.org/10.5935/2595-0118.20190004 BrJP, vol.2, n1, p.14-19, 2019
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Abstract

BACKGROUND AND OBJECTIVES: Labor pain is caused by several physiological changes and may cause psychological damage to the parturient and her relatives and, therefore, must be relieved. The objective of this study was to evaluate the knowledge, attitude, and practice of obstetricians concerning pharmacological methods of labor analgesia.

METHODS: Cross-sectional study (38 obstetricians working at public maternity hospitals). A structured questionnaire was applied about knowledge, attitude and practice concerning systemic and regional pharmacological methods. The agreement magnitude was assessed by kappa coefficient.

RESULTS: We observed adequate knowledge about the indications of all methods (31 to 86%), the contraindications of opioids (92%) and the adverse effects of non-opioid analgesics /antispasmodics on the fetus (76%). Concerning attitude, they agree that non-opioid analgesics/antispasmodics do not minimize labor pain (98%) but should be available at the maternity wards (89%) and that epidural analgesia is effective (100%) and should be available (94%). In practice, the indication of non-opioid analgesics/antispasmodic and epidural analgesia prevailed. In most of the requirements in each dimension (knowledge: K=-0.092 to 0.158; p=0.057 to 1.0 and attitude: K=-0.005 to 0.472; p=0.004 to 1.0), there was minimal agreement with practice, except for the non-opioid analgesics/antispasmodics (K=0.421, p=0.009), and epidural analgesia (K=0.472, p=0.004), with a moderate agreement.

CONCLUSION: Knowledge was heterogeneous. The attitude was unanimous concerning the effectiveness and the need of having epidural available, and the ineffectiveness of non-opioid analgesics/ antispasmodics, and the practice of prescribing them. There was a minimal agreement between knowledge and practice, and between attitude and practice on most of the other requirements in each dimension.

Keywords

Analgesia, Attitude and practice in health, Childbirth pain, Knowledge, Medical education, Obstetric analgesia, Pharmacological treatment

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor do parto é causada por diversas alterações fisiológicas e pode causar danos psicológicos à parturiente e seus familiares, portanto, deve ser aliviada. O objetivo deste estudo foi avaliar o conhecimento, atitude e prática de obstetras sobre métodos farmacológicos de analgesia de parto.

MÉTODOS: Estudo transversal, com amostra de conveniência (38 obstetras que atuam em maternidades públicas). Foi aplicado um questionário estruturado sobre conhecimento, atitude e prática em relação a métodos farmacológicos sistêmicos e regionais. Magnitude de concordância avaliada pelo coeficiente Kappa.

RESULTADOS: Observou-se conhecimento adequado nas indicações de todos os métodos (31 a 86%), contraindicações dos opioides (92%) e efeitos adversos de analgésicos simples/antiespasmódicos no feto (76%). Na atitude, concordam que os analgésicos simples/antiespasmódicos não funcionam no alívio da dor do parto (98%), mas devem estar disponíveis nas maternidades (89%), e que a analgesia peridural é eficaz (100%) e deve estar disponível (94%). Na prática, prevaleceu a indicação de analgésicos simples/antiespasmódicos e da analgesia peridural. Na maioria dos quesitos, em cada dimensão (conhecimento: K=-0,092 a 0,158; p=0,057 a 1,0 e atitude: K=-0,005 a 0,472; p=0,004 a 1,0), houve concordância mínima com a prática, excetuando analgésicos simples/antiespasmódicos (K=0,421; p=0,009) e analgesia peridural (K=0,472; p=0,004), com concordância moderada.

CONCLUSÃO: O conhecimento foi heterogêneo. A atitude foi unânime quanto à eficácia e necessidade da analgesia peridural estar disponível, e ineficácia dos analgésicos simples e antiespasmódicos, e a prática de prescrevê-los. Houve concordância mínima entre o conhecimento e a prática, e entre a atitude e a prática, na maioria dos outros quesitos em cada uma das dimensões.

Palavras-chave

Analgesia, Analgesia obstétrica, Atitudes e prática em saúde, Conhecimentos, Dor do parto, Educação médica, Tratamento farmacológico

References

Anjos KF, Santos VC, Souzas R. Parto, aborto e puerpério: assistência humanizada à mulher. Rev Bras Ginecol Obstet. 2010;13(1):44-55.

Camano LSE. Assistência ao Parto e Tocurgia. 2002:1-324.

Anderson D. A review of systemic opioids commonly used for labor pain relief. J Midwifery Womens Health. 2011;56(3):222-39.

Kaliyaperumal K. Guideline for conducting a knowledge, attitude and practice (KAP) study. Community Ophthalmol. 2004;4(1):7-9.

Wang Y, Zhu R, Huang N, Li W, Yang L, Zhang S. Knowledge, attitudes, and practices survey of drug allergy among healthcare practitioners in central China: a multicenter study. Asia Pac Allergy. 2016;6(2):105-11.

Magalhães VC, Oliveira DL, Prado FO. Knowledge, risk perception and attitudes of Dentistry students with regard to HIV/AIDS. RGO, Rev Gaúch Odontol. 2015;63(3):291-300.

Silveira NS, Vasconcelos CT, Nicolau AI, Oriá MO, Pinheiro PN, Pinheiro AK. Knowledge, attitude and practice of the smear test and its relation with female age. Rev Lat Am Enfermagem. 2016:24.

Colak D, Oguz A, Yazilitas D, Imanaglu IG, Altinbas M. Morphine: patient knowledge and attitudes in the central anatolia part of Turkey. Asian Pac J Cancer Prev. 2014;15(12):4983-8.

Lopes FS, Duarte AC, Gusman PB, Silva D, Ganem EM, Barros GA. Evaluation of the knowledge of postoperative pain among participants of a virtual scientific journey in Anesthesiology. Rev Dor. 2016;17(2):111-6.

Ke LS, Chiu TY, Lo SS, Hu WY. Knowledge, attitudes, and behavioral intentions of nurses toward providing artificial nutrition and hydration for terminal cancer patients in Taiwan. Cancer Nurs. 2008;31(1):67-76.

Dias IM, Almeida SM, Dias JM, Leite IC. 'Specialists' perception and opinion about self-medication of patients with temporomandibular disorders and orofacial pain. Rev Dor. 2017;18(1):32-7.

Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database Syst Rev. 2012.

Scopolamine systemic drug information. 2017.

Jones L, Othman M, Dowswell T. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2013.

Othman M, Jones L, Neilson JP. Non-opioid drugs for pain management in labour. Cochrane Database Syst Rev. 2012.

Tveit TO, Halvorsen A, Seiler S, Rosland JH. Effectiveness and adverse effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. Int J Obstet Anesth. 2013;22(1):19-25.

Diretrizes Nacionais de Assistência ao Parto Normal. 2017.

Klomp T, van Poppel M, Jones L, Lazet J, Di Nisio M, Lagro-Janssen AL. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012.

Gilbert J, Grant M. Pharmacologic management of pain during labor and delivery. 2017.

Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011.

Gil AC. Como elaborar projetos de pesquisa. 2002.

Pereira JCR. Análise de dados qualitativos: Estratégias Metodológicas para as Ciências da Saúde, Humanas e Sociais. 2004.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.

Kim YY, Park JH, Kang HJ, Lee EJ, Ha S, Shin SA. Level of agreement and factors associated with discrepancies between nationwide medical history questionnaires and hospital claims data. J Prev Med Public Health. 2017;50(5):294-302.

Ogboli-Nwasor E, Adaji S, Bature S, Shittu O. Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria. J Pain Res. 2011;4:227-32.

McCauley M, Stewart C, Kebede B. A survey of healthcare providers knowledge and attitudes regarding pain relief in labor for women in Ethiopia. MC Pregnancy Childbirth. 2017;17(1):56.

Escuriet R, Pueyo ML, Perez-Botella M. Cross-sectional study comparing public and private hospitals in Catalonia: is the practice of routine episiotomy changing?. BMC Health Serv Res. 2015;11:15:95.

Chehab M, Courjon M, Eckman-Lacroix A, Ramanah R, Maillet R, Riethmuller D. Impact of a major decrease in the use of episiotomy on perineal tears in a level III maternity ward. J Gynecol Obstet Biol Reprod. 2014;43(6):463-9.

Hehir MP, Reidy FR, Wilkinson MN, Mahony R. Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences. Eur J Obstet Gynecol Reprod Biol. 2013;171(1):40-3.

proposição de conteúdo dos programas de residência médica. 2006.

Submitted date:
10/12/2018

Accepted date:
12/14/2018

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