Practice of analgesia in an emergency department of eastern Nepal

Authors

  • Rabin Bhandari BP Koirala Institute of Health Sciences

DOI:

https://doi.org/10.31729/jnma.522

Abstract

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.

Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70).  Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.

Key Words: Analgesia, Emergency, Nepal

Author Biography

Rabin Bhandari, BP Koirala Institute of Health Sciences

Associate Professor

Department Of General Practice And Emeregency Medicine

References

References
1. Todd KH, Ducharme J, Choiniere M, Scrandall C, Fosnocht DE, Home P et al. Pain in the Emergency Department:Results of the Pain and Emergency Medicine Initiative (PEMI) Multicenter Study. The Journal of Pain. 2007;8:460–466.
2. Motov SM, Khan ANGA. Problems and barriers of pain management in the emergency department: Are we ever going to get better? Journal of Pain Research. 2009;2:5–11.
3. Size M, Soyannwo OA, Justins DM. Pain management in developing countries. Anaesthesia. 2007;62(Suppl.1):38–43.
4. Ducharme J, Tanabe P, Homel P, Miner JR, Chang AK, Lee J et al. The influence of triage systems and triage scores on timeliness of ED analgesic administration. American Journal of Emergency Medicine. 2008;26:867–873.
5. Fielding R, Irwin MG. The knowledge and perceptions of nurses and interns regarding acute pain and postoperative pain control. Hong Kong Med J. 2006;12(Suppl.1):S31-48.
6. Chung CH. The use of injectable nonsteroidal anti-inflammatory drugs in local accident and emergency practice. Hong Kong Journal of Emergency Medicine. 2002;9:65-714.
7. Zimmerman O, Halpern P. Opinion Survey of Analgesia for Abdominal Pain in Israeli Emergency Departments. The Israel Medical Association Journal. 2004;6:681-685.
8. Silka PA, Roth MM, Moreno G, Merrill L, Geiderman JM. Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency Department. Academic Emergency Medicine. 2004 Mar;11:37.
9. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Undertreatment of acute pain in the emergency department: a challenge. International Journal for Quality in Health Care. 2005;17:173–176.
10. Yanuka M, Halpern P. An Interventional study to improve the quality of analgesia in the emergency department. Emergency Medicine Journal. 2002;19(Suppl.I):A20–A40.
11. Goh HK, Choo SE, Lee I, Tham KY. Emergency department triage nurse initiated pain management. Hong Kong Journal of Emergency Medicine. 2007;14:16-21.
12. Lim GH, Wee FC, Seow E. Pain management in the emergency department. Hong Kong Journal of Emergency Medicine. 2006;13:38-45.

Published

2003-12-31

How to Cite

Bhandari, R. (2003). Practice of analgesia in an emergency department of eastern Nepal. Journal of Nepal Medical Association, 42(150). https://doi.org/10.31729/jnma.522

Issue

Section

Original Article