Twenty four hour outcome of pain control and associated factors among adult patients with isolated long bone fractures seen at the Mulago hospital accident and emergency unit.

Abstract

Background: Pain is defined as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue. It is experienced by almost all patients with long bone fractures (LBFs), that significantly impacts their quality of life and recovery outcomes yet studies indicate that acute pain in patients with LBFs is often undertreated, leading to unnecessary suffering and potential complications such as chronic pain. This study aimed to determine the twenty four hour outcome of pain control and associated factors among adult patients with isolated long bone fractures seen at the Mulago National Referral Hospital Accident and Emergency (MNRH A&E) department Methods: We did a fragmented cross-sectional study among 130 adult patients presenting with isolated long bone fractures at the MNRH A&E department. Pain intensity scores were obtained using the NRS tool at admission and during administration of the subsequent treatments up to 4 times in 24 hours. Other relevant data were collected using a structured questionnaire and analyzed using SPSS version 27 Results: The participants' mean age was 30 years and ranged from 18 to 66 years. Males were predominant with a ratio of 2:1. High energy trauma was the most common mechanism of injury accounting for 115 (89%) cases. 85 (65%) participants had closed fractures. Combined tibia and fibula fractures were the most common and occurred in 65 (50%) participants. Overall, 8 (6.2%), 6 (4.6%), 8 (6.2%) and 4 (3.1%) participants had adequate pain control at 6, 12, 18 and 24 hours respectively. Participants with a caretaker and those who were given multimodal analgesia were generally less likely to have inadequate pain control while those with severe pain at admission, inadequate fracture splinting were more likely to have inadequate pain control at all the 4 times of assessment in 24 hours. Conclusion: 93.8%, 95.4%, 93.8% and 96.9% of patients with isolated long bone fractures had inadequate pain control at 6, 12, 18 and 24 hours of assessment respectively. Availability of acaretaker and administration of multimodal analgesia were protective factors against inadequate pain control while severe pain at admission, inadequate fracture splinting and unavailability of analgesic drugs at the MNRH A&E department were risk factors for inadequate pain control. We recommend that MNRH A&E should follow the WHO guidelines on pain management