A Research Thesis Submitted to the Department of Anesthesia, College of Medicine and Health Science, University of Gondar in Partial Fulfillment of the of Requirements for the Degree of Masters in Advanced Clinical Anesthesia

Abstract

Abstract Background: Adequate pain management has led to increased comfort in emergency patients and also has been shown to reduce morbidity and improve long term outcomes. Several factors have been associated with poor pain management in low resource setting areas. There are different pain management modalities in the emergency department among which systemic analgesia is commonly used by preceding a nerve block and non-pharmacological pain management techniques. Objective: The aim of this study was to determine pain management modalities and associated factors in emergency surgical patients. Methods: After obtaining ethical approval from Ethical review commetee, 203 willing patients were enrolled in this study of consecutive sampling technique. Institutional based cross - sectional prospective study was conducted from April to May 31, 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured by numerical rating scale and statistical analysis was performed using SPSS statistical package version 23 .Descriptive statistics, cross –tab and binary logistics were performed to identify factors related to pain management in emergency department. Results: A total of 203 patients, 138 males and 65 females with response rate of 94% were participated in this study among them 66% patient’s analgesic delivered within two hours of ED presentation with a mean ± standard deviation of 61.0 ± 34.1 minute and 70.4 % complained moderate and severe pain after analgesia. There was a significant difference between trauma and non-trauma patients on mean time of analgesia and residual pain severity with a p value of < 0.001. Tramadol was commonly administered drug followed by diclofenac 39.9% and 19.7% of patients respectively. Age (30-59) of the patient, trauma, physician pain assessment and severity of pain (severe pain) were an predictor factors for analgesia delivery with an adjusted odd ration of 4.04,3.99 ,3.09 and 3.49 in the emergency department respectively. Conclusion: The overall practice of pain management in Gondar University Specialized Hospital emergency department was not satisfactory and pain assessment was not by standardized tools as well as there was no appropriate documentation.