Pain management among adult patients with fractures of long bones attended at the emergency department of Muhimbili orthopeadic istitution(MOI)

Abstract

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is one of the leading complaints in emergency departments (EDs). This study was carried out in order to determine pain management among patients with long bone fractures attended at the Emergency Department of Mumbili Orthopaedic Institute and to come up with recommendations for pain management strategies for the institute.

Descriptive Cross-sectional study design (Hospital based) was used. The study population was patients with fractures of long bones and aged 18 - 60 years old. All patients with long bones fractures seen at the ED, MOl during the study period were recruited until the sample size was achieved. A total of 250 patients were included in the study. Structured interview and observation guide were used to collect data. Verbal rating scale was used, to determine the intensity of pain. Analysis of the data included univariate analysis, P-values and 95% confidence intervals (Cl) are provided in bivariate analysis. Chi-squire test was used when testing the relationships between variables.

The study shows that there is no documentation for pain assessment or reassessment at Emergency Department. The prevalence of analgesics administration before and after admission in at the ED was 40.4% (101) and 46% (115), respectively. A total of 54% (135/250) of patients were not given any analgesics. For those who received analgesics, the commonest analgesic given to was Diclofenac sodium (46%). No single patient was given opioids (pethedine/ morphine). These finding suggests that the phenomenon of oligoanalgesia is more widespread. It was also noted that there is a reluctance to use opioids in this setting. The rate of analgesics administration or splinting before and after admission to the ED did not differ between sex (p=0.314 versus p= 0.230) and (p=0.314 versus p= 0.114), respectively. Almost half (47.0%) of them spent >20 min to lhr before the administration of analgesics. After administration of analgesia 76% of the patients continued to have severe to moderate pain. A total of 156 (62.4%) patients scored their pain as severe at the ED and among these, only 28 (17.9%) of patients received analgesia within 20 mins, 42 (26.9%) patients after 30min to l hour, while 73 (46.8%) of patients were not given analgesics despite scoring severe pain. Pain at ED is under treated; there was no documentation of pain assessment or reassessment of the pain resulting in inadequate dosage and delay to administer analgesia to relive pain. Opioids were not used to relive pain and majority patients with severe pain were not given analgesia at ED or prescription of analgesia after discharge.