Pain management and regional anaesthesia in the trauma patient

Abstract

Educating the emergency room staff to perform early routine assessment of pain and to be familiar with the administration of analgesia are key elements to improved pain management in trauma. Peripheral nerve block techniques should be practised by emergency room staff. If simple techniques are chosen, competence can be achieved with short, focused training sessions. Further developments are needed in order to provide safer and more effective analgesia to the trauma patient.

Quality of life 2–7 years after major trauma

“…Pain management in the acute phase of trauma is obviously important. Improved pain management in the trauma patient not only increases comfort and reduces unnecessary suffering, but has also been shown to reduce morbidity and improve long‐term outcomes (25, 26). Furthermore, unrelieved acute pain has been shown to induce changes in the nervous system that can lead to the development of chronic disabling neuropathic pain (26).…”

“…Improved pain management in the trauma patient not only increases comfort and reduces unnecessary suffering, but has also been shown to reduce morbidity and improve long‐term outcomes (25, 26). Furthermore, unrelieved acute pain has been shown to induce changes in the nervous system that can lead to the development of chronic disabling neuropathic pain (26). More studies are necessary to improve our understanding about the mechanisms of chronic post‐injury pain, to find out which patients are at risk and to develop effective treatment strategies (27).…”

Wilderness Medical Society Practice Guidelines for the Treatment of Acute Pain in Remote Environments: 2014 Update

“…These include inappropriate estimation of pain by the provider, a lack of medication or the means to administer the necessary analgesics, lack of pharmacologic knowledge, a fear of addiction, concern of masking potential clinical deterioration, and life-threatening side effects such as respiratory depression, hemodynamic instability, and aspiration. 3,4 Acute untreated pain is not the only consequence of inadequate analgesia. Failure to adequately manage pain may also cause a significant stress response as well as an increase in the risk of developing posttraumatic stress disorder.…”

Prehospital ultrasound-guided nerve blocks improve reduction-feasibility of dislocated extremity injuries compared to systemic analgesia. A randomized controlled trial

“…Certainly, an optimized pain management approach in trauma patients may lead not only to increased patient comfort but also has the potential to improve outcomes. Thus, enhanced focus on adequate analgesia, especially in trauma cases, has been shown to be associated with decreased morbidity [ 3 , 4 ]. Early fracture reduction, limiting complications and sequelae, may be the primary surgical objective.…”