Relief of Pain in Trauma Patients

Abstract

Worldwide, trauma is the major problem in the public health; it is a major cause of mortality and morbidity. Trauma is the leading cause of death in age group 1-44years. Trauma kills victims in this age group more than all diseases combined, and creates additional complications with permenant injuries and disabilities. The term "stress response" represents the human physiologic response to injury regardless of it is cause. The clinical consequences of such a response include hypertension, tachycardia, cardiac arrhythmias, protein catabolism, immune system suppression, hypercoagualable state, and elevated oxygen consumption. The pattern of injury is determined by trauma mechanisms, and current knowledge focuses the clinician priorities in treating any injured patient. Therapeutic interventions differ according to trauma mechanisms. Pressure trauma is the most common type of trauma, and it can be blunt or penetrating. Most commonly blunt trauma results from motor vehicle crashes or falls, where widespread energy transfer to the body is encountered. Sustained injuries such as multiple fractures, soft tissue contusions or avulsion, and rupture of visceral organs occur when the limits of load tolerance are exceeded resulting in disruption of tissues. On the other hand, penetrating objects, such as a bullet, knife, or broken long bone shaft, cause tissue stretching and crushing. The injury is usually confined to the track of penetrating object. Other trauma mechanisms include heat, electricity, and drowning, and in all cases tissue damage and/or loss may occur. "Pain is, with very few, if indeed any exceptions, mor-ally and physically a mighty and unqualified evil. And, surely, any means by which it is abolition could possibly be accomplished, with security and safety, deserves to be joy-fully and gratefully welcomed by medical science". One critical aspect on trauma management is dealing with pain. It is nowadays, well understood that appropriate treatment of pain in injured patients would improve care re-sults. Injured patients are often experiencing considerable pain while being unstable. Such instability makes these pa-tients susceptible to analgesic interventions. Morbidity and mortality are high among trauma patients due to various effects on their vital systems. Trauma complications, such as hypovolemia, coagulopathies, and head or spine injuries are frequently encountered and would limit several pain relief approaches. In the recent decades, there have been significant advances in posttraumatic pain management. This added to the increased awareness of the consequences of under treating posttraumatic pain, has produced adaption of the therapeutic concepts, such as multimodal and multidisciplinary approaches to pain in injured patients. Once pain has been assessed, interventions directed to-ward pain relief must be implemented. Pain management can be divided into pharmacological and non-pharmacological interventions. A variety of comfort-producing measures were implemented, including endotracheal suctioning, repositioning in bed, massage, oral care, and reassurance. Principles of pharmacological management begin with preemptive analgesia (before the pain or as soon as possible after the pain begins). Preemptive analgesia not only reduces the pain response but also reduce the chance of long-term sequelae. Analgesia should be regarded as part of the resuscita-tion or treatment process as it brings pain relief, improved hemodynamic stability, improved organ and tissue perfusion, and overall improvement in morbidity and mortality. Regional anesthetic techniques provide excellent peri-operative analgesia that may improve patient outcome. Most often, regional anesthesia techniques for traumatized patient are first utilized in the operating room for procedural anesthesia or for postoperative pain control.