Pain management in patients with long-bone fractures in a district hospital in KwaZulu-Natal, South Africa

BACKGROUND: This study reviewed pain severity and assessment as recalled by patients with long-bone fractures. The focus was on the intervals between admission, pain assessment and analgesic provision, as delay of analgesia for acute pain can result in complex chronic pain syndromes. AIM: The aims were to explore patients’ recollection of pain severity and assessment in an emergency department (ED) and whether analgesia prescribed in the ED correlated with pain severity. SETTING: The study site was a district hospital ED in KwaZulu-Natal, South Africa. METHODS: This exploratory study considered aspects of pain in adults with long-bone fracture who were admitted to an ED and later referred to an orthopaedic unit. Data collection took place in the orthopaedic unit where participants were requested to recall their pain severity (using a visual analogue scale) whilst in the ED. RESULTS: Ninety-three patients participated, most of whom were African males. Over 60% recalled their pain severity in the ED as 5 or greater on a visual analogue perception scale. No formal tool was used to assess or record pain in the ED, and there was no association between recalled pain severity and type of analgesia prescribed. CONCLUSION: The majority of patients were assessed for pain in the ED. Analgesia given to most patients was inadequate for the degree of pain they experienced. A pain assessment protocol should be developed for doctors and nurses to serve as a guideline in assessing patients with long-bone fractures and prescribing appropriate analgesia.