Regional Anesthesia in Traumatic Injury- Implications for Acute and Chronic Pain

Katherine Durant, MD1,2, Emmanuel Perez, MD1, Michael Block, MD1,2, Mark Schlesinger, MD1,2

1Hackensack University Medical Center, Department of Anesthesiology, Hackensack NJ

2Hackensack Meridian School of Medicine

 

INTRODUCTION

Background: Patients who sustain

orthopedic traumatic injuries are more

likely than the general population to

suffer from chronic pain syndromes and

opioid misuse.

Guideline: Multimodal analgesia is the

recommended way to manage trauma

patients’ pain

Gap: Most patients are treated with

opioids and face barriers to receiving

regional anesthesia in the acute setting

 

CASE 1

Overview: 21 year old man with left

open patella fracture with dislocation,

and left posterior wall acetabular

fracture with left hip dislocation due to

MVC

Intervention: General anesthesia and

ultrasound guided single shot left

femoral and pericapsular nerve group

(PENG) peripheral nerve blocks

Main outcome measures: In the PACU,

the patient had a pain score rating of

0/10 and required 4mg oral morphine

equivalents (OME) in the first twenty

four hours after surgery

 

CASE 2

Overview: 53-year-old woman with a

closed patellar fracture after a

mechanical fall from standing height

Intervention: General anesthesia only

Main outcome measures: In the

PACU, the patient had a pain score

rating of 10/10 and required 36mg

OME in the first twenty four hours

after surgery

 

DISCUSSION

Inadequate pain control in trauma patients is associated with

poor quality of life, development of chronic pain disorders,

and opioid misuse

One of the most modifiable risk factors to developing chronic

pain syndromes and opioid misuse is inadequate acute pain

management

Opioids have become the “status quo” in acute pain

management for orthopedic injuries, however they can

interfere with recovery, can lead to opioid related adverse

events such as respiratory depression, and cause negative

long-term consequences like opioid dependence.

 

CONCLUSIONS

Patients with acute orthopedic

traumatic injuries are at high risk for

developing short-term and long-term

consequences related to inadequate

acute pain management.

Regional anesthesia should be used as

part of the multimodal pain regimen

when possible

 

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