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34 - Pharmacologic Management of Acute Pain in Trauma

Published online by Cambridge University Press:  18 January 2010

Shalini Dhir
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Veerabadran Velayutham
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. Evaluate pain management modalities in the acutely injured patient.

  2. Review the pharmacology of acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs, opioids, tramadol, local anesthetics, and ketamine in trauma patients.

  3. Discuss the role of antidepressants, anticonvulsants, benzodiazepines, alpha 2 agonists, and entonox for acute pain in trauma.

  4. Discuss the role of multimodal analgesia for trauma patients.

INTRODUCTION

The widely accepted definition of pain was developed by a taxonomy task force of the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms” [1]. Managing pain can be challenging in most scenarios and providing adequate pain relief forms a vital part in the initial management of trauma. Inadequate analgesia in acute situations can have deleterious effects on the immune system, healing process, and autonomic activity and can lead to the development of a chronic pain state (see Chapter 35).

PATHOPHYSIOLOGY OF STRESS RESPONSE TO INJURY AND PAIN

Pain is a protective response. This reflex response has an effect on multiple systems in the body. These include exaggerated stress response, sleep deprivation, altered glucose homeostasis, increased sympathetic nervous system activation, and altered gastrointestinal, renal, and endocrine function. The stress response produced has effects on various organ systems additionally such as cardiovascular, immune, endocrine, and respiratory systems. Thus, the stress response to injury is a complex hormonal and neurologic phenomenon. In a trauma patient, the consequences of this response are multifactorial.

Type
Chapter
Information
Trauma Anesthesia , pp. 528 - 543
Publisher: Cambridge University Press
Print publication year: 2008

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  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, 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/CBO9780511547447.037
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  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, 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/CBO9780511547447.037
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, 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/CBO9780511547447.037
Available formats
×