Retrospective evaluation of pain management in patients presenting to the emergency department with hand trauma

SUMMARY Objective: The aim of this study is to retrospectively evaluate pain management approaches in patients who presented to the emergency department with hand injuries requiring Plastic and Reconstructive Surgery consultation, comparing the efficacy of various analgesic protocols containing diclofenac, tramadol, and fentanyl. Method: This study included patients who presented to the Emergency Department of Karadeniz Technical University with hand trauma and received treatment with diclofenac, tramadol, or fentanyl between May 2023 and May 2024. The patients were divided into three different groups according to the treatment administered: Diclofenac, Diclofenac + Tramadol, and Diclofenac + Fentanyl After administering these treatment combinations, the patients' pain levels were assessed at the 10th, 20th, 30th, and 60th minutes following their arrival using Visual Analog Scale (VAS) scores, and their responses to treatment, along with their demographic data, were evaluated. Additionally, the patients were grouped based on the level of injury (finger, hand, wrist) and the type of trauma (fracture, tendon damage, amputation, soft tissue loss). Their pain levels were compared by measuring VAS scores at the 10th, 20th, 30th, 60th minutes after the treatment combinations were administered. Results: A statistically significant decrease in VAS scores was observed across all treatment groups, regardless of injury level and trauma type (p<0.001). When compared based on injury levels, a statistically significant decrease in VAS scores was found in all treatment groups (p<0.001). The change in VAS scores measured in patients with tendon injury, fracture, and amputation across different treatment groups was found to be significant (p<0.05). The change in VAS scores measured in patients with soft tissue injury and those with both tendon injury and fracture across different treatment groups was not found to be significant (p = 0.118 and p=0.064, respectively). Conclusion: According to the results of our study, we found that all drug groups effectively reduced patients' pain levels, regardless of the type of trauma and injury level. Additionally, we determined that the diclofenac + fentanyl treatment was more effective in reducing VAS scores across all types of trauma. Keywords: Diclofenac, tramadol, fentanyl, hand trauma, pain