Pre- and postoperative pain management practices in fracture surgery: A bicentric prospective observational study in Ethiopia

TL;DR

This study found that most patients in Ethiopia receive inadequate pain management before and after fracture surgery, with strong opioids rarely used even for severe pain.

Contribution

The study provides empirical evidence on pain management practices in traumatic fracture surgery in Ethiopia, highlighting gaps and associated factors.

Findings

74.8% of patients had inadequate preoperative pain management, improving to 42.2% postoperatively.

Only 56.4% of patients received analgesics preoperatively, while 99.1% received them postoperatively.

Strong opioids were not prescribed for severe pain, and lower education and psychological factors were linked to poor pain management.

Abstract

Acute pain is common following orthopedic trauma and surgery. This study aims to evaluate the adequacy of pre- and postoperative pain management in traumatic fracture patients undergoing orthopedic surgery in Ethiopia.

A prospective cohort study was conducted at two Ethiopian trauma centers from January 2019 to October 2021. Preoperatively, data was obtained on sociodemographic factors, substance use, type of injury, pain and psychological factors. Pain was assessed again 24 h following surgery. Pain management adequacy was evaluated using the Pain Management Index (PMI), based on the World Health Organization’s pain treatment framework. The PMI was determined by subtracting the patient’s pain intensity from the strength of the prescribed analgesic scores range from − 3 to + 3. Negative values indicate inadequate pain control.

Of the 220 patients enrolled, 218 completed the study. Preoperative pain was inadequately managed in 74.8% of patients, improving to 42.2% postoperatively. Most patients reported mild (23.3%), moderate (43.1%), or severe (30.8%) pain preoperatively, yet 56.4% received no analgesics. At 24 h post-surgery, the patients reported mild (5.0%), moderate (53.7%), and severe (41.3%) pain, with 99.1% receiving analgesics. Notably, no patients with severe pain were given strong opioids at any time point. Lower educational level was associated with inadequate preoperative pain management (AOR: 3.18; 95% CI: 1.19–8.54). Alcohol use (AOR: 2.80; 95% CI: 1.30–6.05), higher anxiety (AOR: 1.17; 95% CI: 1.05–1.30), and higher depression scores (AOR: 0.77; 95% CI: 0.68–0.88) were associated with inadequate pain management 24 h post-surgery.

Most patients with traumatic fractures received inadequate perioperative pain management, especially before surgery. Strong opioids were not used even in cases of severe pain. Socio-demographic and psychological factors were significantly associated with inadequate pain management.

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