Research Article: Quality of postoperative pain management in Ethiopia: A prospective longitudinal study

Date Published: May 1, 2019

Publisher: Public Library of Science

Author(s): Million Tesfaye Eshete, Petra I. Baeumler, Matthias Siebeck, Markos Tesfaye, Abraham Haileamlak, Girma G. Michael, Yemane Ayele, Dominik Irnich, Yan Li.


The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. In Africa, there are scanty data available that make use of multi-center data to characterize the quality of postoperative pain management. In this study using a longitudinal data, we have attempted to characterize the quality of postoperative pain management; among patients scheduled for major elective orthopedic, gynecologic and general surgery.

This prospective longitudinal study evaluated the quality of postoperative pain management in patients undergoing elective general, gynecologic, and orthopedic surgery. We quantified the prevalence of moderate to severe postoperative pain with the International Pain Outcome Questionnaire and the corresponding adequacy of treatment with the pain management index. At four time points after surgery, we estimated pain severity, its physical and emotional interference, and patient satisfaction.

Moderate to severe postoperative pain was present in 88.2% of patients, and pain was inadequately treated in 58.4% of these patients. Chronic pain (β = 0.346, 95% CI: 0.212, 0.480) predicted patients’ worst pain intensity. Gender was not associated with the worst pain intensity or percentage of time spent in severe pain. Patient’s pain intensity did not predicted the level of satisfaction.

The prevalence of moderate to severe postoperative pain and its functional interference is high in Ethiopian patients. The treatment provided to patients is inadequate and not in line with international recommendations and standards.

Partial Text

In the year 2012 alone, 266.2 to 359.5 million operations were performed, representing a 38% increase over the previous eight years; low-income countries thereby had the most dramatic increase [1]. The rise in the number of operations is not without risk; for example, after analyzing 5000 patients a study acknowledged that 22% of chronic pain is caused by surgery [2]. Postoperative pain is still problematic, and up to 40% of patients have severe pain [3].

We provide substantial evidence that postoperative pain management at the three study centers, which were more or less representative for Ethiopia, was insufficient and that pain impaired patients’ physical functioning and emotional well-being during the postoperative period. Most of the analgesics were prescribed by the surgical residents. This seems to have an important implication for the destiny of pain management in the setting. For instance, in battling the opioid crisis, developed world have already identified that agents of change should be the surgical resident as larger amount of opioid were prescribed by them [22]. In the same manner Ethiopia might be benefited if started early to target these group of professionals (surgical resident) to halt the possible tramadol crisis [23]. A high prevalence of moderate to severe postoperative pain was observed. Such a high prevalence might be comparable to studies conducted the early 2000s; for example, a study in the USA reported a prevalence of up to 86% [24]. However, the prevalence found in our study is unacceptably high compared with recent studies from both developed [25] and developing countries [9], which reported prevalences of 34% and 62%, respectively. Even two days after surgery (48 h), 40% of patients were in moderate to severe pain, which is still higher than in other settings in Africa [26].

This study suggests that postoperative pain is not well managed at hospitals in Ethiopia and that there is an unacceptably high prevalence of moderate to severe postoperative pain. It also provides evidence indicating a severe interference of pain with patients’ functional activities in bed, which could result in several complications. It is important to aim to improve the quality of postoperative pain management. Additionally, this report confirmed that patients are satisfied with the postoperative care provided to them, despite having higher pain intensity scores. In limited resource settings, attention needs to be paid to implementing interventions that reduce the amount of pain and aim to deliver high-quality postoperative pain management.