Pain Management in the Unstable Trauma Patient
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PAIN MANAGEMENT IN TRAUMA (MR HOFFMAN, SECTION EDITOR)
Pain Management in the Unstable Trauma Patient Mackenzie Cook 1 & Cassie Barton 2 Accepted: 15 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Review the current literature regarding the optimal approach to pain control in unstable trauma patients, specifically focusing on the initial management of pain and rapid transition to multi-modal agents. Recent Findings There is a clear benefit to multi-modal analgesia instituted as rapidly as possible in trauma patients. While early management of pain depends upon the use of short-acting IV opioids, the rapid transition to adjunctive pain control strategies is optimal. The benefits include not only improved patient experience but also improved physiologic parameters and lower longterm risk of chronic pain and disability. Summary The initial management of pain in unstable trauma patients is focused on titrating short-acting IV opioids to effect. Rapid institutions of multi-modal pain control, however, can improve short-term pain management while reducing the physiologic load imposed by uncontrolled pain and reduce the risk of long-term chronic pain and opioid misuse. Keywords Multi-modal analgesia . Pain management in unstable trauma patients . Benefits of early analgesia
Introduction The management of the unstable trauma patient is a time pressured and difficult undertaking with multiple competing concerns. A key paradigm shift in civilian and military trauma management has been the early treatment of pain, starting at the injury scene and continuing throughout the continuum of care [1]. While physiologic management is directed towards the primary survey, it is important to remember that injured patients are in pain and management of pain is an essential component of their care [2]. The etiologies of pain in the acutely injured trauma patient are myriad, stemming not only from their injury patterns but also from the pain triggered by therapeutic interventions and exacerbated by psychological distress, anxiety, intoxication, This article is part of the Topical Collection on Pain Management in Trauma * Mackenzie Cook [email protected] 1
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and delirium. The assessment of pain is made more difficult because of alterations in the level of consciousness, traumatic brain injury, alcohol, or other drug intoxications. A patient’s satisfaction regarding their pain control can be remarkably unreliable as pain control satisfaction has been reported as high, despite moderate to high levels of reported pain [3]. In this review, we will focus on the management of acute pain in the unstable trauma patient. We will review the longterm benefits of aggressive early pain control. While we will not discuss the pathophysiology of nociceptive and neuropathic pain, we will discuss the pharmacology and potential utility of a variety of analgesic agents and provide recommendations for the management of pain in the pre-operative setting. We will conclude by reviewing recommendations for management in hemodynami
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