50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Case Description:

79 y/o man, PMHx HTN, obesity presented after fall from a truck bed resulting in bilateral rib fractures, right hemopneumothorax, thoracic vertebral body fractures, grade II splenic injury
Underwent posterior fusion of thoracic vertebrae (Figure 1)
Post-operative course complicated by severe acute colonic pseudo-obstruction (Ogilvie's syndrome) s/p colectomy complicated by fascial dehiscence and anastomotic leak
Return to OR for anastomotic resection and end ileostomy creation (Figure 2)
Liposomal bupivacaine injected by surgical team

How We Improved Analgesia:

Single shot intrathecal morphine injection (200 mcg) at L4 - L5
Day after, intrathecal catheter placement with fentanyl-bupivacaine infusion (2ml/hr)

Result:

Prior to intervention, patient reported pain 10/10 (NRS), followed by improvement of pain to 2/10 after intrathecal morphine injection on POD1.
Placement of intrathecal catheter with infusion on POD2 continued to provide pain relief and improve involvement in PT/OT.

Discussion:

Polytrauma creates unique pain profiles that often limit pain modalities due to trauma burden
Creative pain modalities tailored to patient trauma can decrease hospital stay, improve pain scale, and lead to improvement in involvement in care

NAVIGATING COMPLEX POLYTRAUMA IN THE CRITICAL CARE UNIT: NOVEL APPROACHES TO PAIN RELIEF WHEN MULTIMODAL OPTIONS SEEM TO RUN OUT