Socio-Demographic Characteristics
Majority of the patients, 71(60.2%) were males and females were 47 (39.8%). The overall Mean age of the patients was 42.65(±14.13). Concerning educational status most of the patients 45 (38.1%) were primary level and only 11 (9.3%) were tertiary level. The rest of the demographic and clinical details of the participants are shown in Table 1.
Table 1: Socio-demographic characteristics of the patient
Variables
|
|
EM n (%)
|
SBM n (%)
|
Total n (%)
|
p-value
|
Gender
|
|
|
|
|
0.851
|
|
Male
|
36 (61.0%)
|
35 (59.3%)
|
71 (60.2%)
|
|
Female
|
23 (39.0%)
|
24 (40.7%)
|
47 (39.8%)
|
Age M(SD)
|
41.19(±13.25)
|
44.12(±14.93)
|
42.65 (±14.13)
|
0.851
|
|
18-39
|
24(40.7%)
|
23(39.0%)
|
47(39.8%)
|
|
|
40- 64
|
35(59.3%)
|
36(61.0%)
|
71(60.2%)
|
|
Level of Education
|
|
|
|
0.463
|
|
Tertiary level
|
3(5.1%)
|
8(13.6%)
|
11(9.3%)
|
|
|
Secondary level
|
21(35.6%)
|
18(30.5%)
|
39(33.1%)
|
|
|
Primary level
|
23(39.0%)
|
22(37.3%)
|
45(38.1%)
|
|
|
Illiterate
|
12(20.3%)
|
11(18.6%)
|
23(19.5%)
|
|
Ethnicity
|
|
|
|
|
0.569
|
|
Tigrigna
|
51(86.4%)
|
53(89.8%)
|
104(88.1%)
|
|
|
Others*
|
8(13.6%)
|
6(10.2%)
|
14(11.9%)
|
|
Occupation
|
|
|
|
0.856
|
|
Employed
|
13(22.0%)
|
12(20.3%)
|
25(21.2%)
|
|
|
Self-employed
|
21(35.6%)
|
19(32.2%)
|
40(33.9%)
|
|
|
Unemployed
|
25(42.4%)
|
28(47.5%)
|
53(44.9%)
|
|
*Includes Tigre, Saho, Bilen and Nara
|
|
|
Clinical Characteristics of the patients
The summary on the clinical characteristics of the patients is illustrated in Table 2. A high proportion of patients 71(60.2%) had spinal anaesthesia whereas orthopaedic surgery was 66 (55.9%). Among the patients who had general surgery 29 (55.8%) performed major surgery. History of previous surgery was found only in 38 (32.2%) of the patients and majority of the patients 105 (89%) were ASA grade I.
Table 2: Clinical characteristics of the patients in the EM and SBM.
Variables
|
|
EM n (%)
|
SBM n (%)
|
Total n (%)
|
p-value
|
Type of Anesthesia
|
|
|
|
0.851
|
|
General Anesthesia
|
24 (40.7%)
|
23 (39.0%)
|
47 (39.8%)
|
|
Spinal Anesthesia
|
35 (59.3%)
|
36 (61.0%)
|
71 (60.2%)
|
Type of Surgery
|
|
|
|
1.000
|
|
General Surgery
|
26(44.1%)
|
26(44.1%)
|
52(44.1%)
|
|
Orthopedic Surgery
|
33(55.9%)
|
33(55.9%)
|
66(55.9%)
|
Type of General Surgery
|
|
|
0.780
|
|
Major surgery
|
14(53.8%)
|
15(57.7%)
|
29(55.8%)
|
|
Minor surgery
|
12(46.2%)
|
11(42.3%)
|
23(44.2%)
|
Type of Orthopedic Surgery
|
|
|
0.566
|
|
Upper Extremity
|
7(21.2%)
|
9(27.3%)
|
16(24.4%)
|
|
Lower Extremity
|
26(78.8%)
|
24(72.7%)
|
50(75.8%)
|
History of Previous Surgery
|
|
|
0.694
|
|
Yes
|
20(33.9%)
|
18(30.5%)
|
38(32.2%)
|
|
No
|
39(66.1%)
|
41(69.5%)
|
80(67.8%)
|
ASA grade
|
|
|
|
0.769
|
|
ASA I
|
53(89.8%)
|
52(88.1%)
|
105(89.0%)
|
|
ASA II
|
6(10.2%)
|
7(11.9%)
|
13(11.0%)
|
Severity of POP
In the EM prior to treatment, 98.3% of the patients experienced POP. Majority of them (67.8%) were in moderate to severe pain. On day 0 prevalence of POP was 96.6%, where mild pain was (28.8%), moderate pain was (55.9%) and severe pain was (11.9%). On day1, 98.3% of the patients experienced POP where moderate to severe was 39%. During day 2, 81.4% of the patients had POP where 20.3% had moderate to severe pain. In the SBM prior to intervention, 88.1% of the patients suffered POP, out of which 76.2% were in moderate to severe pain. On day 0, 89.8% of the patients suffered POP in which 57.7% had moderate to severe pain. On day 1, 94.9% of the patients had POP and only 18.6% had moderate to severe pain. During day 2 57.6% the patients had POP, in which majority 52.5% were in mild pain. The severity of POP in the EM and SBM from day 0 to day 2 is demonstrated in table 3.
Table 3: Severity of POP
|
|
Day 0
|
Day 1
|
Day 2
|
EM
|
|
|
|
|
|
No pain
|
3.4%
|
1.7%
|
18.6%
|
|
Mild pain
|
28.8%
|
59.3%
|
61.0%
|
|
Moderate pain
|
55.9%
|
37.3%
|
16.9%
|
|
Severe pain
|
11.9%
|
1.7%
|
3.4%
|
SBM
|
|
|
|
|
|
No pain
|
10.2%
|
5.1%
|
42.4%
|
|
Mild pain
|
32.2%
|
76.3%
|
52.5%
|
|
Moderate pain
|
42.4%
|
16.9%
|
5.1%
|
|
Severe pain
|
15.3%
|
1.7%
|
0.0%
|
Type of analgesic used
In the EM group of the patients who suffered POP (81.4%), (44.1%) and (49.2%) received analgesia during day 0, 1, and 2 respectively. The types of analgesics administered were Diclofenac (63.72%), Ibuprofen (32.35%), Acetaminophen (12.74%), Metamizol and Pethidine (0.98%) each. In the SBM all patients who had experienced POP received analgesia. The type of analgesics used in the SBM were acetaminophen as a solo analgesic 53.1%, acetaminophen plus ibuprofen 36.73% and acetaminophen plus ibuprofen plus Tilidine 10.18%.
Clinically effective pain reduction
Clinically effective pain reduction was found in 44.8% and 65.4% of the patients in the EM and SBM groups respectively at the 1st post-treatment pain assessment. At the 2nd post-treatment pain assessment of the patients, 45.6% in EM group and 54.3% in SBM group had clinically effective pain reduction. At the 3rd post-treatment pain assessment, 50% in the EM group and 52.1% in the SBM group clinically effective pain reduction was found. At the 4th post-treatment pain assessment, majority of the patients (75%) had clinically effective pain reduction in the SBM group, but only 31.4% of the patients had in the EM group. In the 5th post-treatment pain assessment, 47.8% had clinically effective pain reduction in the EM group whereas in the SBM group majority of the patients (80.0%) had clinically effective pain reduction.
Effectiveness of POP Management in the EM group and SBM group
Summary of the median pain reduction found at the series post-treatment pain assessment in the EM group and SBM group is shown in table 4. The median pain reduction found at the series post-treatment pain assessment in the EM was statistically insignificant with (Chi-square=9.23, p=0.560). On the other hand, the median pain reduction at the series of post-treatment pain assessment found in the SBM was statistically significant with (Chi-square=22.70, p<0.001).
Table 4: Median pain reduction found during the series of post-treatment pain assessment in the EM group and SBM group.
Management Type
|
Median (IQR)
|
Minimum
|
Maximum
|
Chi-square(df)
|
p-value
|
EM
|
|
|
|
9.23(4)
|
0.056
|
At Pre-treatment
|
4.50(3.70)
|
0
|
10
|
|
|
At post-treatment 1
|
1.00(3.70)
|
-4.70
|
8.00
|
|
|
At post-treatment 2
|
0.40(3.70)
|
-5.10
|
7.10
|
|
|
At post-treatment 3
|
0.00((3.70)
|
-8.40
|
7.50
|
|
|
At post-treatment 4
|
0.20(2.40)
|
-3.30
|
5.00
|
|
|
At post-treatment 5
|
0.40(1.50)
|
-5.10
|
5.50
|
|
|
SBM
|
|
|
|
22.70(4)
|
<0.001
|
At Pre-treatment
|
4.60(2.80)
|
0
|
9.5
|
|
|
At post-treatment 1
|
1.70(3.50)
|
-4.00
|
7.60
|
|
|
At post-treatment 2
|
0.00(4.00)
|
-4.40
|
7.10
|
|
|
At post-treatment 3
|
0.20(3.20)
|
-6.50
|
5.20
|
|
|
At post-treatment 4
|
0.80(2.10)
|
-4.00
|
6.50
|
|
|
At post-treatment 5
|
0.30(1.00)
|
-3.00
|
4.80
|
|
|
Significance of Clinically Effective Pain Reduction
At the 1st post-treatment pain assessment the pain reduction was significantly greater than 30% in the SBM while in the EM was not significantly different from 30%. At the 2nd post-treatment pain assessment the pain reduction was significantly less than 30% in both the EM and SBM. At the 3rd post-treatment pain assessment the pain reduction was not significantly different from 30% in both the EM and SBM. At the 4th post-treatment pain assessment in the EM the pain reduction was significantly less than 30% whereas in the SBM was not significantly different from 30%. At the 5th post-treatment pain assessment the pain reduction was significantly greater than 30% in the SBM while in the EM was not significantly different from 30%. Table 5 displays the significance of clinically effective pain reduction.
Table 5: Significance of clinically effective pain reduction
|
|
Difference
|
95% CI
|
p-value
|
At post-treatment 1
|
|
|
|
EM
|
-20.97
|
(-43.21, 1.27)
|
0.064
|
|
SBM
|
14.54
|
(2.61, 26.48)
|
0.018
|
At post-treatment 2
|
|
|
|
EM
|
-63.58
|
(-120.13, -7.03)
|
0.028
|
|
SBM
|
-44.31
|
(-85.43, -3.19)
|
0.035
|
At post-treatment 3
|
|
|
|
|
EM
|
-62.80
|
(-131.09, 5.49)
|
0.071
|
|
SBM
|
-38.00
|
(-81.24, 5.23)
|
0.083
|
At post-treatment 4
|
|
|
|
EM
|
-31.06
|
(-57.55, -4.56)
|
0.022
|
|
SBM
|
4.02
|
(-22.05, 30.09)
|
0.757
|
At post-treatment 5
|
|
|
|
|
EM
|
-14.29
|
(-38.29, 9.71)
|
0.237
|
|
SBM
|
24.01
|
(1.61, 46.42)
|
0.036
|
Association of Selected Socio-demographic and Clinical Variables with Effectiveness of POP Management
From the selected socio-demographic variables middle aged adults with a (P-value 0.026) andfemales with a (p-value 0.016) were found to have significant difference with effectiveness of POP managementbetween the EM andSBM. Regarding to the type of anesthesia, the effectiveness of POP management in those patients who took GA had significant difference (p- value<0.001). The effectiveness of POP management those patients who had general surgery had significant difference (p-value <0.001) between the EM and SBM. The rest association of the selected socio-demographic and clinical variables with effectiveness of POP management is expressed in table 6.
Table 6: Association of selected socio-demographic and clinical variables with effectiveness of POP
Variables
|
|
|
Median
|
Mann-Whitney U
|
P-value
|
Age
|
|
|
|
|
|
|
18-39
|
EM
|
2.05(3.77)
|
268.50
|
0.873
|
|
|
SBM
|
3.06(3.38)
|
|
|
|
40-64
|
EM
|
1.34(3.70)
|
436.50
|
0.026
|
|
|
SBM
|
3.06(3.38)
|
|
|
Gender
|
|
|
|
|
|
|
Male
|
EM
|
1.95(4.00)
|
591.50
|
0.658
|
|
|
SBM
|
3.06(3.06)
|
|
|
|
Female
|
EM
|
0.90(3.48)
|
163.00
|
0.016
|
|
|
SBM
|
3.19(2.19)
|
|
|
Type of anesthesia
|
|
|
|
|
|
|
GA
|
EM
|
0.81(2.60)
|
103.50
|
<0.01
|
|
|
SBM
|
3.06(2.02)
|
|
|
|
SA
|
EM
|
3.28(3.40)
|
606.00
|
0.783
|
|
|
SBM
|
3.20(3.31)
|
|
|
Type of Surgery
|
General Surgery
|
EM
|
0.88(3.17)
|
169.00
|
0.002
|
|
|
SBM
|
3.41(1.92)
|
|
|
|
Orthopedic Surgery
|
EM
|
2.40(3.64)
|
519.00
|
0.744
|
|
|
SBM
|
2.58(3.19)
|
|
|