Postoperative pain management among surgically treated patients in an Ethiopian hospital

PLoS One. 2014 Jul 17;9(7):e102835. doi: 10.1371/journal.pone.0102835. eCollection 2014.

Abstract

Background: Incidence of postoperative pain has been reported to be between 47-100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia.

Methods and findings: A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach's α coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients' charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar's; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r = 0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status.

Conclusion: Despite patients' paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / therapeutic use*
  • Cross-Sectional Studies
  • Diclofenac / therapeutic use
  • Ethiopia
  • Female
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Pain Management / methods
  • Pain Measurement / methods
  • Pain, Postoperative / drug therapy*
  • Patient Satisfaction
  • Prospective Studies
  • Tramadol / therapeutic use
  • Young Adult

Substances

  • Analgesics
  • Diclofenac
  • Tramadol

Grants and funding

This research was conducted as a partial fulfillment for a Master of Science in Clinical Pharmacy awarded to the primary author Tewodros Eyob Woldehaimanot and it was solely sponsored by the hosting Jimma University. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.