A Prospective Study on Optimizing Post-Operative Pain Management for Orbital Fracture Surgery Patients

Abstract

Background: The Royal London Hospital (RLH) surgically manages approximately 40 orbital fractures annually. A retrospective review of 20 cases revealed the absence of a standardized post-operative pain management protocol, with 90% of patients reporting pain of unspecified severity. This prospective project aimed to assess current practices for managing post-operative pain in orbital fracture patients during inpatient care and after discharge, and to identify opportunities for improvement to reduce variability in outcomes. Data Collection: Consecutive patients undergoing orbital fracture repair were identified from surgical waiting lists. Intra-operative variables such as fracture severity, operation duration, use of local anesthetic, and patient-specific plates were recorded. Analgesic medications prescribed intra-operatively, for inpatient care, and discharge were thoroughly documented. Post-operative pain levels and satisfaction with pain management were recorded using the Numeric Rating Scale (NRS). Both outcome measures were collected daily from the evening of surgery through seven days post-operatively. This enabled an assessment of how effectively post-operative pain was managed, based on patients' perceptions of their pain levels and adequacy of pain management. Result(s): Our data revealed that orbital fracture patients experience varied yet consistently high average pain scores post-operatively, highlighting current practices in managing their pain. A deeper analysis of patient factors, surgical variables, and analgesic regimens informed the development of local guidelines to better address analgesic requirements following surgical intervention for orbital fractures. Conclusion(s): Given the significant variability in pain outcome scores, we propose implementing and evaluating a standardized analgesic protocol to reduce variability and enhance patient satisfaction and comfort.Copyright © 2025