title: Use of analgesia in an emergency department.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Practice and Emergency, BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Rabin
authors.initials: R
authors.lastname: Bhandari
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Malla
authors.forename: Indrajit Prasad
authors.initials: IP
authors.lastname: Mahato
authors.forename: Pramendra
authors.initials: P
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004008:Diclofenac / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009390:Nepal; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D013997:Time Factors; D014147:Tramadol / Q000627:therapeutic use*; D014218:Triage; D055815:Young Adult
chemical_list: D000700:Analgesics; D004008:Diclofenac; D014147:Tramadol; D009020:Morphine
keywords: analgesia, emergency, Nepal.