Getachew Mestawet, Lerdal Anners, Melaku Tsegaye, Lindberg Maren Falch
Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway.
Langenbecks Arch Surg. 2025 Aug 13;410(1):246. doi: 10.1007/s00423-025-03837-y.
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.
急性疼痛在骨科创伤和手术后很常见。本研究旨在评估埃塞俄比亚接受骨科手术的创伤性骨折患者术前和术后疼痛管理的充分性。
2019年1月至2021年10月在埃塞俄比亚的两个创伤中心进行了一项前瞻性队列研究。术前，获取了社会人口学因素、物质使用情况、损伤类型、疼痛和心理因素的数据。术后24小时再次评估疼痛。基于世界卫生组织的疼痛治疗框架，使用疼痛管理指数（PMI）评估疼痛管理的充分性。PMI通过从规定的镇痛评分强度中减去患者的疼痛强度来确定，范围为-3至+3。负值表示疼痛控制不足。
在纳入的220例患者中，218例完成了研究。74.8%的患者术前疼痛管理不足，术后改善至42.2%。大多数患者术前报告轻度（23.3%）、中度（43.1%）或重度（30.8%）疼痛，但56.4%的患者未接受任何镇痛药。术后24小时，患者报告轻度（5.0%）、中度（53.7%）和重度（41.3%）疼痛，99.1%的患者接受了镇痛药。值得注意的是，在任何时间点，没有重度疼痛患者使用强效阿片类药物。较低的教育水平与术前疼痛管理不足相关（调整后比值比：3.18；95%置信区间：1.19-8.54）。饮酒（调整后比值比：2.80；95%置信区间：1.30-6.05）、较高的焦虑（调整后比值比：1.17；95%置信区间：1.05-1.30）和较高的抑郁评分（调整后比值比：0.77；95%置信区间：0.68-0.88）与术后24小时疼痛管理不足相关。
大多数创伤性骨折患者围手术期疼痛管理不足，尤其是术前。即使在重度疼痛病例中也未使用强效阿片类药物。社会人口学和心理因素与疼痛管理不足显著相关。
