{"title":"Pre- and postoperative pain management practices in fracture surgery: A bicentric prospective observational study in Ethiopia.","authors":"Mestawet Getachew, Anners Lerdal, Tsegaye Melaku, Maren Falch Lindberg","doi":"10.1007/s00423-025-03837-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"246"},"PeriodicalIF":1.8000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350506/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Langenbeck's Archives of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00423-025-03837-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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