Assessment of Post-Operative Pain Management among Patient’s Undergoing Lower Limb Surgery at Muhimbili Orthopedic Institute Dar Es Salaam Tanzania

Abstract

Background: Lower limb surgery is a common operative procedure in both general surgery and orthopedic practice. Postoperative pain (POP) after orthopedic surgery is more difficult to manage and is often associated with the highest POP scores. In sub-Saharan Africa (SSA), motor traffic accidents (MTA) are the most common cause of trauma and therefore lower limb surgery is very common. Patients undergoing lower limb surgery often suffer from inadequate pain management despite of the increasing advancement in POP management and development of pain control modalities. Studies from both developed and developing countries have revealed high prevalence of POP and poor patient satisfaction. Assessment of POP management and patient satisfaction is important in order to improve medical service. In Tanzania there is limited information regarding lower limb POP management and patient satisfaction hence this study aim to provide evidence for improving POP management in the clinical settings. Objectives: The objective was to assess the postoperative pain management Materials and Methodology: This was a clinical based descriptive cross-sectional study. One hundred and forty eight (148) patients aged 18 years and above who underwent lower limb surgeries at Muhimbili Orthopedic Institute, from24th July 2016 to 24th December 2016 were recruited.Pilot tested structured questionnaire was used to collect social demographic, post- operative medication and clinical data. Data were analyzed using the SPSS V.20. Chi-square was used to detect differences in the frequencies of categorical characteristics and statistical significance was set at P ≤0.05. Results: Sixty nine (69%) of the participants were male with mean age of 36.99±15.7 years. Immediately after surgery, majority of the patients were reported to have mild pain (76.4%), few moderate pain (23.6%), and none reported severe pain (0%). At 24 hours’ post-operative, higher proportion of patients were having moderate pain (52.7%) followed by those who were experiencing severe (43.9%) and 7.4% mild pain. At 48 hours post-operative, majority of participants had mild pain (54.7%), (39.9%) moderate pain and again small percentages were having severe pain (1.4%).Upon 48 hours, most of the patients were not satisfied (69%)while only minor proportion were satisfied with POPM. High proportions of patients who were satisfied with postoperative pain management received a combination of analgesia with different frequency of drug administration, different route compared to those who received single analgesic intramuscular 8hourly and 12hourly. Following the first 24hours, large proportions of the participants were given Diclofenac alone compared to those who received Tramadol alone or combination of Diclofenac and Paracetamol. Intramuscular route was a leading route of drug administration compare to intravenous and combination with different route, most of the drugs were given 8hourly compare to those which were given 12hourly or in combination with different frequency. Conclusions: Pain severity was moderate to severe at 12hours to 24hours postoperative. Pain management was not satisfactory post operatively to most patients. It was observed multimodal analgesia favored good post-operative pain management.