• Mari A Griffioen, Melissa L Ziegler, Robert V O'Toole, Susan G Dorsey, and Cynthia L Renn.
• School of Nursing, University of Delaware, Newark, Delaware. Electronic address: mgriffi@udel.edu.
• Pain Manag Nurs. 2019 Apr 1; 20 (2): 158-163.

BackgroundEffective acute pain management following injury is critical to improve short-and long-term patient outcomes. Analgesics can effectively reduce pain intensity, yet half of injury patients report moderate to severe pain during hospitalization.PurposeThe primary aim of this study was to identify the analgesic, different analgesic combinations, or analgesic and adjuvant analgesic combination that generated the largest percent change from pre- to post-analgesic pain score.DesignThis was a descriptive retrospective cohort study of 129 adults admitted with lower extremity fractures to a trauma center.MethodsName, dose, and frequency of analgesics and adjuvant analgesics administered from admission to discharge were collected from medical records. Percent change was calculated from pain scores documented on the 0-10 numeric rating scale.ResultsThe analgesic with largest percent change from pre- to post-administration pain score was hydromorphone 2 mg IV (53%) for the emergency department and morphine 4 mg IV (54%) for the in-patient unit. All analgesics administered in the emergency department and ∼50% administered on the in-patient unit produced a minimal (15%) decrease in pain score.ConclusionsThis study revealed that few analgesics administered in the emergency department and the in-patient unit to patients with lower extremity fractures provide adequate pain relief. In the emergency department, all analgesics administered resulted in at least minimal improvement of pain. On the in-patient unit 13 analgesic doses resulted at least minimal improvement in pain while nine doses did not even reach 20% change in pain. Findings from this study can be used guide the treatment of fracture pain in the hospital.Copyright © 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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