Background Sleep quality refers to a sense of being refreshed and rested after waking up from sleep. Postoperative patients were vulnerable to poor sleep quality due to having different contributing factors. The prevalence of poor sleep quality among postsurgical patients was left undisclosed in our study setting. Knowing the prevalence and contributing factors for poor sleep quality helps us to develop a strategic plan for prevention and management. Method and materials A multicenter cross-sectional study design was conducted on 424 postsurgical patients who were selected by a systematic random sampling method. Data was collected using the Pittsburgh Sleep Quality Index by a face-to-face interview. Data analysis was done using SPSS version 25. For categorical data, a chi-square test was done. Bivariable and multivariable analyses were performed to determine whether each of the independent variables is associated with the outcome variable. Result Based on this study result, the prevalence of poor sleep quality was 64.9%. Among the factors included in this study, variables which had an association with poor postoperative sleep quality were age range 25–54 years (AOR = 15.13), male gender (AOR = 4.81), educational level of secondary school (AOR = 6.29), patient income less than 2500 birr (AOR = 3.77), anxiety (AOR = 2.53), depression(AOR = 22.8), light exposure(AOR = 19.60), poor social support (AOR = 1.98), being emergency surgery (AOR = 2.46) and having a history of moderate to severe pain (AOR = 38.18, (95% CI). Conclusion Poor sleep quality among adult post-surgical patients was significantly high in Amhara regional comprehensive referral hospitals. Therefore; Clinicians need to prioritize postoperative sleep quality assessment and needs to minimize factors inducing postoperative sleep disturbances.

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

Introduction Femoral bone fracture is the predominant, lower limb orthopedic surgery that is associated with severe acute and persistent chronic pain that needs better postoperative pain management. Untreated postoperative pain results inability to do physiotherapy resulting in stiffens of joints and immobility. This study aimed to compare the postoperative analgesic efficacy of three-in-one-block versus fascia iliaca block in patients who underwent surgically treated femoral fractured patients under spinal anesthesia. Methods A prospective cohort study was conducted on 110 elective surgically treated femoral fractured orthopedic patients from January to October 2021. Data were entered into epi-data 4.4.2 and imported into a statistical package of social science version 22 for analysis. Shapiro-Wilk normality test was used to check the normality of the data and normally distributed data were analyzed using Student's independent t-test, whereas non-normally distributed variables were analyzed with Mann-Whitney U-test. The comparisons of categorical parameters were analyzed using the chi-square test and Fisher's exact test. Finally p-value < 0.05 was declared to be statistically significant. Result The median and interquartile range of the postoperative numerical rating scale at rest and on movement was significantly less in three-in-one-block (3IN1B) as compared with fascia-iliaca block (FICB). But at 30 min no significantly different between the two pain management modalities. Moreover, the meantime to seek the first request of analgesia was significantly prolonged in 3IN1B compared with FICB. Regarding the total analgesic consumption, the mean total tramadol consumption was 97. 27 ± 53. 07 and 180 ± 72.96 (p < 0.001) and Diclofenac 53.18 ± 29.28 and 72 ± 43.54 (p < 0. 001) in 3IN1 and FICB, respectively. Conclusion The present study concludes that three-in-one-block provides more effective analgesia, reduced postoperative analgesic requirements, and prolonged first analgesics requests compared with fascia iliaca block, and Landmark technique fascia-iliaca block (FICB) is an alternative pain management modality in a resource-limited setting.

BackgroundPostoperative depression is one of the devastating problems and important health concerns in adult orthopedics surgical patients. It is often under-diagnosed and appropriate perioperative management of patients is recommended. This study aimed to determine the magnitude and factors associated with postoperative depression among orthopedics patients in Ethiopia.Materials and MethodsThis multi-center cross-sectional study was conducted on 443 adult post-orthopedics surgical patients. All the data were entered and analyzed with SPSS version 25. Bivariable and multivariable logistic regression was used to identify the associated factors with the outcome variable. P-values &lt;0.05 were taken as statistically significant with 95% CI. Data were collected after distributing 9-item standard patient health questionnaires and the Oslo-3 item social support scale tool.ResultBased on our study result, the magnitude of postoperative depression among adult orthopedics surgical patients was 61.8% (95% CI: 56.8–65.7). Using multivariable logistic regression analysis, factors which had an association with postoperative depression were female in gender, Farmer in occupation, having a history of previous substance use, history of anxiety, Patients who had moderate to poor social support, BMI &lt;18.5 kg/m2, and patients who had an open fracture.ConclusionThe magnitude of postoperative depression was high. Due emphasis needs to be given to screening and treatment of postoperative depression, especially among patients of the female gender, farmer occupation, moderate to poor social support, history of substance use and anxiety, low BMI, and open fracture.