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31 - Trauma and Regional Anesthesia

Published online by Cambridge University Press:  18 January 2010

By
Shalini Dhir  and
Sugantha Ganapathy
Edited by
Charles E. Smith
Shalini Dhir
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Sugantha Ganapathy
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Discuss the mechanisms of acute pain after trauma.

  2. Evaluate posttraumatic pain modalities.

  3. Describe the use of regional anesthesia for trauma patients including brachial plexus blocks, epidurals, and lower limb blocks.

INTRODUCTION

Pain is now considered the fifth vital sign. However, inadequate treatment of pain is common and can result in chronic pain syndromes in up to 69 percent of patients [1, 2]. This is more likely in the trauma setting, as pain often is the last priority in a patient who is hemodynamically unstable. Fortunately, this is changing. The joint commission on Accreditation of Healthcare Organizations recently stated that “unrelieved pain has physical and psychological effects” and that the patient's right to pain management should be respected and supported and that pain must be assessed in all patients [3].

Polytrauma involves injuries to multiple organs requiring emergent or urgent surgeries. The involvement of the central nervous system (CNS), cardiorespiratory system, as well as peripheral limbs results in significant pain to the patient. There is inadequate time to deal with such severe pain due to the need for lifesaving surgical procedures. The caregivers are often worried about masking clinical signs of major organ injury involving the CNS, abdomen, and chest viscera. Caregivers at the emergency site or in emergency rooms may be inadequately trained on the pain management modalities that are currently available. For a long time, regional blocks were not adequately exploited in the emergency rooms for pain management, but the trend is currently changing.

Type
Chapter
Information
Trauma Anesthesia , pp. 471 - 498
Publisher: Cambridge University Press
Print publication year: 2008

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  • Trauma and Regional Anesthesia
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.034
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  • Trauma and Regional Anesthesia
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.034
Available formats
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  • Trauma and Regional Anesthesia
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.034
Available formats
×