Advancing Maternal Pain Management After Cesarean Delivery in a Rural Tanzanian Hospital Through Hybrid Global Health Education.

BACKGROUND

Focused anesthesia education may be beneficial for resource-constrained settings where inadequate training along with lack of infrastructure, staff, and supplies can contribute to high anesthetic morbidity and mortality rates. Some medical outreach efforts have transitioned from short-term and service-focused "missions" to education-focused global health interventions to build health care capacity. The Stanford Anesthesiology Division of Global Health Equity partnered with Foundation for African Medicine and Education (FAME), a hospital in Karatu, Tanzania, to introduce regional anesthesia through virtual workshops and in-person bidirectional exchange. This study aimed to assess the translation of hybrid global health education in regional anesthesia to improvements on maternal post-cesarean delivery pain.

METHODS

From 2020 to 2023, the FAME team was trained in regional and acute pain techniques via virtual biannual 2-week workshops. The FAME head nurse anesthetist visited Stanford for a 5-week observership in October 2023, then a Stanford team traveled to Tanzania in January 2024 for 4 weeks of hands-on regional anesthesia training. The nurse anesthetists identified obstetric anesthesia as an area for application. Postsurgical pain management pathways were developed, introducing numerical pain scores and multimodal analgesia including transversus abdominis plane (TAP) blocks. Primary outcomes included maximum pain scores reported for the first 12 hours, pain scores at 12 hours and at 24 hours after C-section. Secondary outcomes included postoperative analgesic prescriptions, side effects, and hospital length of stay.

RESULTS

Mean maximum pain scores after C-section were significantly decreased (preintervention: 7.6 ± 1.9 [mean ± standard deviation {SD}] versus postintervention: 4.5 ± 1.6, P < . 001). Smaller decreases in pain scores were observed at 12 hours (2.5 ± 1.3 vs 2.2 ± 1.1, P < . 05) and 24 hours (1.1 ± 0.9 vs 0.7 ± 0.9, P < . 01). Multimodal analgesia was utilized with reduction in scheduled tramadol (97.9% vs 69.9%, P < . 001) and reduced side effect profiles (dizziness [29.3% vs 16.8%, P < . 05] and nausea/vomiting [24.3% vs 8.8%, P < . 001]).

CONCLUSIONS

This study demonstrates the impact of global health educational interventions, including virtual workshops and bidirectional exchange, on maternal pain outcomes in a Tanzanian hospital. Preintervention data collection fostered heightened awareness among the FAME nurse anesthetists of the severity of post-cesarean pain. The introduction of TAP blocks further improved their existing multimodal analgesic strategy with a clinically significant reduction in maximum pain scores. This educational strategy aims to advance global anesthesia goals, including building longitudinal partnership, thereby enhancing access to safe anesthesia education and promoting sustainable capacity building.