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Drevet S, Boussat B, Grevy A, Brevet A, Olive F, Richard M, Marchesi L, Guyomard A, Maindet C, Pailhe R, Rubens-Duval B, Bouzat P, Tonetti J, Bioteau C, Gavazzi G, Francois P, Gibert P. Perioperative pain management intervention in older patients with hip fracture in an orthogeriatric unit. A controlled before/after study assessing an audit and feedback intervention (PAIN-AGE). BMC Geriatr 2024; 24:735. [PMID: 39237920 PMCID: PMC11375881 DOI: 10.1186/s12877-024-05282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Postoperative pain delays ambulation, extends hospital stay, reduces the probability of recovery, and increases risk of long-term functional impairment. Pain management in hip fractured patients poses a challenge to the healthcare teams. Older adults are more vulnerable to opioid-associated side effect and it is primordial to minimize their exposure to opioids. Acetaminophen is associated with reduced opioid use so we need to focus on acetaminophen use in first-line analgesia. METHODS We conducted a controlled before/after study to assess the ability of an audit and feedback (A&F) intervention built with nurses to improve the quality of perioperative pain management in older patients hospitalized for hip fracture in an orthogeriatric unit (experimental group) versus a conventional orthopedic unit (no A&F intervention). The primary endpoint was the percentage of patients who received 3 g/day of acetaminophen during the three postoperative days, before and after the A&F intervention. Secondary endpoints included nurses' adherence to medical prescriptions, clinical data associated with patients and finally factors associated with intervention. The significative level was set at 0.05 for statistical analysis. RESULTS We studied data from 397 patients (mean age 89 years, 75% female). During the postoperative period, 16% of patients from the experimental group received 3 g/day of acetaminophen before the A&F intervention; the percentage reached 60% after the intervention. The likelihood of receiving 3 g/day of acetaminophen during the postoperative period and adhering to the medical prescription of acetaminophen were significantly increased in the experimental group as compared with the control group. The patient's functional status at discharge (assessed by Activities of Daily Living scores) was significantly better and the length of hospital stay significantly reduced after the A&F intervention. CONCLUSION Our controlled before/after study showed that an A&F intervention significantly improved perioperative pain management in older adults hospitalized for hip fracture. Involving teams in continuous education programs appears crucial to improve the quality of pain management and ensure nurses' adherence to medical prescriptions.
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Affiliation(s)
- Sabine Drevet
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France.
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France.
| | - Bastien Boussat
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Clinical Epidemiology and Medical Evaluation - Quality of Care Unit, Grenoble, France
| | - Armance Grevy
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Pharmacy Department, Grenoble, France
| | - Audrey Brevet
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France
| | - Frederic Olive
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Public Health Department, Grenoble, France
| | - Marion Richard
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Anesthesiology Department, Grenoble, France
| | - Laura Marchesi
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France
| | - Alize Guyomard
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Clinical Epidemiology and Medical Evaluation - Quality of Care Unit, Grenoble, France
| | - Caroline Maindet
- Center for Pain Treatment, University Hospital Grenoble Alpes, Grenoble, France
| | - Regis Pailhe
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes Southern Site, Orthopaedic and Traumatology Surgery Department, Grenoble, France
| | - Brice Rubens-Duval
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes Southern Site, Orthopaedic and Traumatology Surgery Department, Grenoble, France
| | - Pierre Bouzat
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Anesthesiology Department, Grenoble, France
- Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, Grenoble, U1216, France
| | - Jérôme Tonetti
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France
| | - Catherine Bioteau
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France
| | - Gaëtan Gavazzi
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department , Grenoble, France
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France
| | - Patrice Francois
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Clinical Epidemiology and Medical Evaluation - Quality of Care Unit, Grenoble, France
| | - Prudence Gibert
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Geriatric Department, Grenoble, France
- Univ. Grenoble Alpes, University Hospital Grenoble Alpes, Pharmacy Department, Grenoble, France
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Sri-On J, Worawiwat T, Luksameearunothai K, Nirunsuk P, Vanichkulbodee A, Fusakul Y, Phisaiphun K, Kanokkarnjana P, Lerdruttanasoontorn D, Thong-on K. Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country. Clin Interv Aging 2024; 19:1225-1233. [PMID: 38974510 PMCID: PMC11227879 DOI: 10.2147/cia.s465006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures. Patients and Methods Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs). Results The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration. Conclusion The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.
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Affiliation(s)
- Jiraporn Sri-On
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Thitarat Worawiwat
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Pornsak Nirunsuk
- Orthopedic Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Alissara Vanichkulbodee
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Yupadee Fusakul
- Department of Rehabilitation Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Krit Phisaiphun
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Pornsiri Kanokkarnjana
- Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Kwannapa Thong-on
- Geriatric Emergency Research Unit, Emergency Department, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
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Graglia S, Harmon D, Klein B. The Development, Implementation, and Evolution of an Emergency Medicine Ultrasound-guided Regional Anesthesia Curriculum. West J Emerg Med 2024; 25:117-121. [PMID: 38205993 PMCID: PMC10777173 DOI: 10.5811/westjem.59793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/19/2023] [Accepted: 10/18/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Despite the inclusion of both diagnostic and procedural ultrasound and regional nerve blocks in the original Model of the Clinical Practice of Emergency Medicine (EM), there is no recommended standardized approach to the incorporation of ultrasound-guided regional anesthesia (UGRA) education in EM training. Methods We developed and implemented a structured curriculum for both EM residents and faculty to learn UGRA in a four-hour workshop. Each Regional Anesthesia Anatomy and Ultrasound Workshop was four hours in length and followed the same format. Focusing on common UGRA blocks, each workshop began with an anatomist-led cadaveric review of the relevant neuromusculoskeletal anatomy followed by a hands-on ultrasound scanning practice for the blocks led by an ultrasound fellowship-trained EM faculty member, fellow, or a postgraduate year (PGY)-4 resident who had previously participated in the workshop. Learners identified the relevant anatomy on point-of-care ultrasound and reviewed how to conduct the blocks. Learners were invited to complete an evaluation of the workshop with Likert-scale and open-ended questions. Results In the 2020 academic year, six regional anesthesia anatomy and ultrasound workshops occurred for EM faculty (two sessions, N = 24) and EM residents (four sessions, N = 40, including a total of five PGY4s, 10 PGY3s, 12 PGY2s, and 13 PGY1s). Workshops were universally well-received by both faculty and residents. Survey results found that 100.0% of all responding participants indicated that they were "very satisfied" with the session. All were likely to recommend this session to a colleague and 95.08% of participants believed the session should become a required component of the EM curriculum. Conclusion The use of UGRA is increasing, and and it critical in EM. An interdisciplinary approach in collaboration with anatomists on an interactive, nerve block workshop incorporating both gross anatomy review and hands-on scanning was shown to be well-received and desired by both EM faculty and residents.
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Affiliation(s)
- Sally Graglia
- University of California San Francisco, Department of Emergency Medicine, San Francisco, California
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Derek Harmon
- University of California San Francisco, School of Medicine, Department of Anatomy, San Francisco, California
| | - Barbie Klein
- University of California San Francisco, School of Medicine, Department of Anatomy, San Francisco, California
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Hernandez N, de Haan JB. Regional Anesthesia for Trauma in the Emergency Department. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pain and related disability remain a major social and therapeutic problem. Comorbidities and therapies increase drug interactions and side effects making pain management more compounded especially in the elderly who are the fastest-growing pain population. Multimodal analgesia consists of using two or more drugs and/or techniques that target different sites of pain, increasing the level of analgesia and decreasing adverse events from treatment. Paracetamol enhances multimodal analgesia in experimental and clinical pain states. Strong preclinical evidence supports that paracetamol has additive and synergistic interactions with anti-inflammatory, opioid and anti-neuropathic drugs in rodent models of nociceptive and neuropathic pain. Clinical studies in young and adult elderly patients confirm the utility of paracetamol in multimodal, non-opioid or opioid-sparing, therapies for the treatment of acute and chronic pain.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology & Intensive Medicine, Department of Medicine - DIMED, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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7
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HOFSTAD JK, KLAKSVIK J, WIK TS. Intraoperatively local infiltration anesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting. Acta Orthop 2022; 93:111-116. [PMID: 34984477 PMCID: PMC8815405 DOI: 10.2340/17453674.2021.806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Local infiltration analgesia (LIA) is commonly used as a component in multimodal analgesia. Pain management directed towards hip fracture patients operated on with hemiarthroplasty is often based on knowledge regarding pain treatment following elective surgery. In this elderly patient population, it is of value to clarify whether adding local infiltration analgesia (LIA) to the postoperative analgesic regimen might reduce postoperative pain or have an opioid-reducing effect. Patients and methods - 96 hip fracture patients undergoing hemiarthroplasty in spinal anesthesia were included. All patients received a multimodal pain regimen and were randomized to receive either ropivacaine or placebo. All patients received morphine depot-opioid and morphine as rescue medication postoperatively. The primary endpoint was pain during mobilization in the recovery unit on the day of surgery. Secondary endpoints were pain during mobilization the day after surgery and postoperative opioid requirements on the first postoperative day. Results - The levels of pain (NRS) during mobilization both in the recovery unit and on the day after surgery were similar in the 2 groups, with median 4 and 0.5 in the placebo group and median 3.5 and 1 in the ropivacaine group respectively. Total consumption of opioids on day 0 and day 1 were 4.6 mg lower in the ropivacaine group (p = 0.04). Pain during mobilization was registered for only 44 of 96 patients for several reasons, including lack of mobilization. Interpretation - There were similar pain scores in both the local infiltration and placebo group postoperatively. However, substantially reduced opioid consumption was found in patients receiving LIA.
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Affiliation(s)
- Janne K HOFSTAD
- Orthopaedic Research Centre, St Olavs Hospital Trondheim, Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim Norway,Norwegian University of Science and Technology, NTNU Trondheim, Norway
| | - Jomar KLAKSVIK
- Orthopaedic Research Centre, St Olavs Hospital Trondheim, Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim Norway,Norwegian University of Science and Technology, NTNU Trondheim, Norway
| | - Tina S WIK
- Orthopaedic Research Centre, St Olavs Hospital Trondheim, Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim Norway,Norwegian University of Science and Technology, NTNU Trondheim, Norway
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8
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Herbst MK, Sorkin R. Ultrasound-guided spinal accessory nerve block for intractable trapezius pain: A case series. Am J Emerg Med 2021; 52:268.e3-268.e7. [PMID: 34417067 DOI: 10.1016/j.ajem.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022] Open
Abstract
Myofascial pain affects about 10% of the United States population, often involves the trapezius muscle, and can be difficult to manage using conventional analgesic medications in the Emergency Department (ED). The use of ultrasound-guided nerve blocks performed by emergency physicians is well-documented, but this is the first report describing the technique and effectiveness of an ultrasound-guided spinal accessory nerve block for acutely treating trapezius myofascial pain in the ED setting. In this case series of three patients with intractable trapezius pain, the ultrasound-guided spinal accessory nerve block proved feasible and offered substantial therapeutic benefit.
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Affiliation(s)
- Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
| | - Ryan Sorkin
- University of Connecticut Emergency Medicine Residency, Department of Emergency Medicine, Farmington, CT, United States of America
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Haines KL, Fuller M, Antonescu I, Vaughan JG, Raghunathan K, Cox CE, Bartz RR, Ohnuma T, Agarwal S, Krishnamoorthy V. Underutilization of Acetaminophen in Older Adult Trauma Patients. Am Surg 2021; 88:2003-2010. [PMID: 34049451 DOI: 10.1177/00031348211023397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period. METHODS Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge. RESULTS Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; P < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group. CONCLUSION Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Matthew Fuller
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Ioana Antonescu
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Justin G Vaughan
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Christopher E Cox
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Raquel R Bartz
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.,Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
| | - Suresh Agarwal
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.,The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, 22957Duke University Medical Center, Durham, NC, USA
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10
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Gosch M, Kammerlander C, Fantin E, Jensen TG, Salazar AML, Olarte C, Bavatonavarech S, Medina C, Link BC, Cunningham M. Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult. Geriatr Orthop Surg Rehabil 2021; 12:21514593211003857. [PMID: 33868767 PMCID: PMC8020218 DOI: 10.1177/21514593211003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Surgeons, internal medicine physicians, nurses, and other members of the
healthcare team managing older adults with a fracture all have barriers to
attending educational courses, including time away from practice and cost.
Our planning group decided to create and evaluate a hospital-based
educational event to address, meet, and improve the care of older adults
with a fracture. Materials and Methods: A committee of surgeons and geriatricians defined 3 learning objectives to
improve knowledge and attitudes in co-managed care. They designed a 1-day
educational event consisting of a departmental visit, a review of cases, a
planning session to identify gaps and plan changes, and presentations on
selected topics. Thirteen hospitals worldwide completed an 8-question online
application form, and 7 sites were selected for delivery over 3 years in
Denmark, Colombia, Thailand, Paraguay, Switzerland, and the Dominican
Republic. Results: Each event was conducted by 1 or more visiting surgeons and geriatricians,
and the local team leaders. The most common challenges reported in the
applications were preoperative assessment or optimization, delayed surgery,
lack of protocols, access to a geriatrician, teamwork, and specific aspects
of perioperative and postoperative care. In each department, 4 or 5 goals
and targets for implementation were agreed. The presentations section was
customized and attended by 20 to 50 team members. Discussion: Topics selected by a majority of departments were principles of co-managed
care (7), preoperative optimization (7), and management of delirium (4).
Follow up was conducted after 3 and 12 months to review the degree of
achievement of each planned change and to identify any barriers to complete
implementation. Conclusions: Hospital-based events with visiting and local faculty were effective to
engage a broader audience that might not attend external courses. A
performance improvement component with goal setting and follow up was
acceptable to all host departments.
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Affiliation(s)
| | | | - Emilio Fantin
- IMC Instituto Modelo de Cardiologia Cordoba, Argentina
| | | | | | | | | | - Claudia Medina
- IPS Universitaria Clínica León XIII, Envigado, Antioquia, Colombia
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11
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Karaarslan N, Yilmaz I, Sirin DY. Toxicity of the acetyl-para-aminophenol group of medicines to intact intervertebral disc tissue cells. Exp Ther Med 2021; 21:147. [PMID: 33456514 PMCID: PMC7791924 DOI: 10.3892/etm.2020.9578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
The present study aimed to investigate the effects of paracetamol, an analgesic and antipyretic that is used in emergency departments and neurosurgery departments for postoperative pain management on intervertebral disc tissue. Paracetamol-treated human primary cell cultures and untreated cell cultures were compared using molecular analyses. Cell proliferation and gene expression were statistically analyzed. Cell proliferation was suppressed on days 10 (P=0.05) and 20 (P<0.05) in the paracetamol-treated groups. Gene expression of chondroadherin, matrix metalloproteinase (MMP)-7, MMP-13 and MMP-19 was higher in the paracetamol-treated samples while gene expression of Cartilage Oligomeric Matrix Protein and interleukin-1β was lower (P<0.05). Paracetamol, which appears innocuous compared with many analgesics, may increase the expression of MMPs, which serve a significant role in catabolic reactions and suppress the proliferation of intact intervertebral disc tissue cells.
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Affiliation(s)
- Numan Karaarslan
- Department of Neurosurgery, School of Medicine, Namik Kemal University, Tekirdag 59100, Turkey
| | - Ibrahim Yilmaz
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Namik Kemal University, Tekirdag 59100, Turkey
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Effectiveness of Multimodal Pain Therapy on Reducing Opioid Use in Surgical Geriatric Hip Fracture Patients. J Trauma Nurs 2020; 27:207-215. [PMID: 32658061 DOI: 10.1097/jtn.0000000000000516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a need for appropriate pain control in the geriatric hip fracture population to prevent diminished function, increased mortality, and opioid dependence. Multimodal pain therapy is one method for reducing pain postoperatively while also decreasing opioid use in the geriatric hip fracture patient. This study aimed to determine whether multimodal pain therapy could decrease opioid use without increasing pain scores in surgical geriatric hip fracture patients. METHODS This was a before-and-after cohort study. The hospital implemented multimodal pain control order sets with a standardized pain regimen and performed retrospective chart review pre- and postorder set implementation for analysis. RESULTS A total of 248 patients were enrolled in the study: 131 in the preorder set group and 117 in the postorder set group. The mean postoperative oral morphine equivalent (OME) was significantly lower in the postorder set group than in the preorder set group (45.1 mg vs. 63.4 mg, respectively, p = .03). Compared with the preorder set group, total OME and postoperative OME were decreased by 22.6% (95% confidence interval [CI] -44.9, -3.8), 1-tailed p < .01, and 53.6% (95% CI -103.4, -16.1), 1-tailed p <.01 respectively, in the postorder set group. There was not a statistically significant difference in mean pain scores at 6, 24, and 48 hr postoperatively (p = .53, .10, and .99), respectively. CONCLUSION Implementing a multimodal approach to pain management may help reduce opioid use and may be a critical maneuver in averting the national opioid epidemic.
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Haines KL, Fuller M, Vaughan JG, Krishnamoorthy V, Raghunathan K, Kasotakis G, Agarwal S, Ohnuma T. The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures. J Surg Res 2020; 255:583-593. [PMID: 32650142 DOI: 10.1016/j.jss.2020.05.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID) use is frequently recommended for multimodal analgesia to reduce opioid use. We hypothesized that increased NSAID utilization will decrease opioid requirements without leading to significant complications in older adult trauma patients undergoing hip fracture repair. METHODS An observational cross-sectional cohort study of 190,057 adult trauma patients over a 6-y period (2008-2014) in the national Premier Healthcare Database was performed. Patients aged 65 or older undergoing femur repair and hip arthroplasty following fractures due to falls were analyzed. Primary outcome was opioid use, and secondary outcomes included transfusion requirements, length of stay (LOS), and organ system dysfunction. Continuous outcomes were analyzed using mixed-effect linear regression models to assess the effect of NSAIDs on the day of surgery. Fixed effects were included for patient and hospital characteristics, comorbidities, co-treatments, and surgery. Random intercepts for each hospital were included to control for clustering. Categorical outcomes were similarly analyzed using mixed-effect logistic regression models. RESULTS NSAIDs decreased opioids prescribed (12.01 versus 11.43 morphine milligram equivalents) (odds ratio [OR], -0.23; confidence interval [CI] = -0.41, -0.06) without overall increased bleeding (40.83% versus 43.18%; OR, 1.02; CI = 0.99, 1.05). NSAIDs were associated with reduced LOS (5.61 versus 5.96 d; CI = -0.24, -0.12), intensive care unit admissions (9.73% versus 10.59%; OR, 0.91; CI = 0.86, 0.96), and pulmonary complications (OR, 0.88; CI = 0.83, 0.93). Additionally, there was a 21% prescribing variability based solely on hospital. CONCLUSIONS NSAIDs were associated with decreased opioid requirements, hospital LOS, and intensive care unit admissions in older adult trauma patients without overall increase in bleeding. NSAIDs should be considered in multimodal pain regimens, moreover, given prescribing variability guidelines are needed. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina.
| | - Matthew Fuller
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Justin G Vaughan
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - George Kasotakis
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Suresh Agarwal
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, Durham, North Carolina; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Abstract
PURPOSE OF REVIEW The purpose is to review current literature on pain management strategies from initial presentation to postoperative care on common fracture types. RECENT FINDINGS - Hip fractures benefit from use of multimodal pain control for early mobility and decreased narcotic requirement. - Distal radius fracture pain during reduction can be managed with hematoma block. Postoperatively, a soft dressing is adequate, and use of a compression glove may improve pain control and edema. - Ankle fractures can be reduced with hematoma block, though use of procedural sedation may reduce reduction attempts for fracture dislocations. - Long bone fracture pain management is trending toward multimodal pain control. Though there is no high-quality evidence, concern that regional anesthesia may mask compartment syndrome has limited its use in high-risk fractures. - The effect of NSAIDs on bone healing has not been conclusively demonstrated. The literature is still inconclusive regarding superiority of either spinal or general anesthesia during operative treatment. Fracture pain control is complex and multifactorial, requiring nuanced clinical judgment in the face of mixed clinical findings.
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Affiliation(s)
- Hannah Elsevier
- Department of Orthopaedic Surgery, Icahn School of Medicine, New York, NY, USA
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Zhou Y, Rui Y, Lu P, Qiu X, Zou J, Li X, Ren L, Liu S, Yang Y, Ma M, Wang C, Chen H. [Research progress of multidisciplinary team co-management models for geriatric hip fracture treatment]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:132-138. [PMID: 31939248 PMCID: PMC8171832 DOI: 10.7507/1002-1892.201904133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/27/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures. METHODS The literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail. RESULTS Clinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality. CONCLUSION The application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.
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Affiliation(s)
- Yangyang Zhou
- Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yunfeng Rui
- Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009,
| | - Panpan Lu
- Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Xiaodong Qiu
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Jihong Zou
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Xingjuan Li
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Liqun Ren
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Songqiao Liu
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Yi Yang
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Ming Ma
- Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Chen Wang
- Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
| | - Hui Chen
- Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China
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Mantuani D, Luftig J, Herring A, Dreyfuss A, Nagdev A. A Novel Technique to Reduce Reliance on Opioids for Analgesia from Acute Appendicitis: The Ultrasound-guided Erector Spinae Plane Block. Clin Pract Cases Emerg Med 2019; 3:248-251. [PMID: 31403099 PMCID: PMC6682230 DOI: 10.5811/cpcem.2019.4.42117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/18/2019] [Accepted: 04/22/2019] [Indexed: 11/21/2022] Open
Abstract
Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.1 The single injection, ultrasound-guided erector spinae plane (ESP) block is a technique safely used for pain control for rib fractures that can be easily performed at the bedside and integrated into optimal emergency care. A more inferiorly located ultrasound-guided ESP block has been recently described in the anesthesia literature for perioperative pain control for various abdominal surgeries but has not yet been described for patients with acute appendicitis. Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.
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Affiliation(s)
- Daniel Mantuani
- Highland General Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Josh Luftig
- Highland General Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Andrew Herring
- Highland General Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Andrea Dreyfuss
- Highland General Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Arun Nagdev
- Highland General Hospital, Alameda Health System, Department of Emergency Medicine, Oakland, California
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Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study. PAIN RESEARCH AND TREATMENT 2019; 2018:5636039. [PMID: 30631598 PMCID: PMC6304567 DOI: 10.1155/2018/5636039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/12/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022]
Abstract
Background Adequate pain management has led to increased comfort in emergency patients, reducing morbidity and improving long term outcomes. Different pain management modalities have been applied in the emergency department among which systemic analgesia is commonly used by preceding a nerve block. Several factors have been associated with poor pain management in low resource setting areas. We aimed to determine pain management modalities and associated factors among emergency surgical patients. Patients and Methods After obtaining ethical approval from Ethical Review Committee, 203 volunteer patients were enrolled. Institutional based cross-sectional prospective study was conducted from April to May 2018 in Gondar University Specialized Hospital Emergency Department. The severity of pain was measured through 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 (68%) males and 65 (32%) females with response rate of 94%, participated in this study. Among them, 66% patients received analgesia within two hours of ED presentation with a mean ± SD of 61.0 ± 34.1 minutes. 70.4 % of patients complained of moderate and severe pain after receiving analgesia. There was a significant difference between trauma and nontrauma patients in mean time of analgesia receiving and residual pain severity (p < 0.001). Age, trauma, physician pain assessment, and severity of pain were the predicting factors for analgesia delivery. Conclusion The overall practice of pain management in Gondar University Specialized Hospital Emergency Department was not adequate. Therefore, it is vital to implement an objective pain assessment method and documentation of the pain severity to improve pain management practice.
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