Introduction: Emergency orthopedic surgeries are performed on a daily and night basis across the world and, different levels of postoperative pain is commonly reported early and late in the postoperative period. Despite the availability of evidence-based international reports, still it is not clearly stated in Ethiopia. Objective: To determine the incidence and associated factors of post operative pain after Emergency Orthopedics Surgery. Methods: A multi-centered prospective observational cohort study was conducted to determine the incidence and associated factors of postoperative pain after emergency orthopedic surgeries from March 1 to May 30, in 2020. Data was analyzed using Statistical Package for Social Sciences, version 20. To identify the association between outcome variable and independent variables, descriptive statistics, cross tabulation and binary logistic regression were used. Categorical data were analyzed using chi-square test. Adjusted odd ratios were computed with 95% confidence interval and p-value < 0.05 was used to determine the significance of the study. Result: The overall incidence of moderate to severe postoperative pain within the first 24 h after emergency orthopedics surgery was 70.5% (95% CI: 64, 77). On multivariable logistic regression analysis; history of having preoperative pain (AOR: 7.92, 95% CI: 3.04, 20.63), history of preoperative anxiety (AOR: 6.42, 95% CI: 2.59, 15.90), preoperative patient expectation about postoperative pain (AOR: 6.89, 95% CI: 2.66, 17.78) and being general anesthesia (AOR: 4.08, 95% CI: 1.30, 12.77) were significantly associated with moderate to severe postoperative pain after emergency orthopedics surgery. Conclusion: Postoperative pain management should be given a high priority in emergency orthopedics surgery. Appropriate pain management strategy should be implemented to decrease postoperative pain suffering. Factors associated with postoperative pain were; preoperative history of pain and anxiety, patient expectation about postoperative pain and being general anesthesia. Highlights:

Introduction: Intraoperative surgical site bleeding is usually common in different types of surgeries. Even though there are different prevention techniques for intraoperative bleeding disorder, now adays deliberate hypotension is highly recommended as management options. Uncontrolled intraoperative bleeding may contribute to disability and even death. It can be the initial sign, and lead to incapacitating symptoms in patients undergoing moderate to major surgery. Method: Electronic search strategies used the following databases: Cochrane library, Pub Med, Medline and various internet search routines, for English publications. Key search terms included in our review are: Deliberate/controlled/induced/permissive hypotension, Intraoperative blood loss, Bleeding control, Intraoperative monitoring, Complication and anesthetic management. Availability of each referenced literature database was assessed until March 15–2019. References classified by evidence levels were selected by one individual and checked by another investigator. Discussion: Deliberate hypotension is listed as one of the blood conservation techniques to be considered with MAP between 50 and 65 mmHg and SBP between 80 and 90 mmHg with little to no reports of complication. A reduction of the patient's blood pressure improved the surgical field operating conditions. Resuscitation should be started after bleeding sites arrested. The most significant factor in deciding when to transfuse is based on one's attitude towards transfusion and the related ‘trigger’ criterion for transfusion. Conclusion: Hypotensive anesthesia protocol allowed perfect hemostasis control significantly with shorter operative time compared with other intraoperative controlling mechanisms for prevention of surgical site bleeding. The range of mean arterial pressure and blood pressure has to be closely monitored and any decrement from the expected range should be managed with vasoactive drugs. Highlights