Pain management in adults during long-bone fracture reduction in the Gaza Strip: a clinical audit

Abstract

Background Ongoing protests in Gaza have led to numerous injuries, including long-bone fractures. We investigated assessment of pain severity and strategies for pain management in the emergency department. As no local guidelines exist, delivered care was compared with the guidance of the UK National Institute for Health and Care Excellence (NICE). Methods A clinical audit was conducted at the emergency department in Dar Al Shifa Medical Complex, Gaza, among patients who attended the emergency department with acute long-bone fractures between April 15 and July 15, 2018. Data were collected on pain assessment methods and strategies for pain management and analgesia administration. Ethics approval was obtained from the Palestinian Ministry of Health. The purpose of the audit was explained to patients and their written consent was obtained before inclusion. Findings Of 79 patients invited to participate, 50 gave consent. 25 patients (50%) were aged 16-24 years, 20 (40%) 25-64 years, and five (10%) 65 years and older. Structured pain assessments were performed in only three patients (6%). No analgesia was administered to patients in the emergency department, except for two patients (4%) received infiltration of lidocaine as analgesia for haematoma.Interpretation No local guidelines for acute pain management in emergency departments exist in the Gaza Strip. Clinical practice showed no adherence to international standards, such as the NICE guidelines for pain management. Factors contributing to such poor management might be large numbers of patients presenting at the time during conflict and protests and that only one room was available in the Shifa' Medical Complex emergency department for examining, assessment, prescribing, and cast application. A limitation of the study is the small sample size is relatively small, but strengths were the 3-month period and prospective enrolment in the emergency department.