Skip to main content
SpringerLink
Log in

Anesthesia and Acute Pain

  • Chapter
  • First Online:
Sports-related Fractures, Dislocations and Trauma

  • 1376 Accesses

Abstract

Pain management is multifactorial and can be delivered in many modalities including oral and parenteral medications, local and regional anesthesia, and procedural sedation. It is important for providers to feel comfortable treating painful conditions and have an understanding of how appropriate matching of analgesia to the painful stimulus can improve patient care and outcomes. This chapter discusses techniques of pain control and provides a guide to options available for patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Schaible HG, Richter F. Pathophysiology of pain. Langenbeck's Arch Surg. 2004;389(4):237–43.

    Article  Google Scholar 

  2. Vanderah TW. Pathophysiology of pain. Med Clin North Am. 2007;91(1):1–12.

    Article  PubMed  Google Scholar 

  3. Coghill RC. Individual differences in the subjective experience of pain: new insights into mechanisms and models. Headache. 2010;50(9):1531–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15:S17–24.

    Article  PubMed  Google Scholar 

  5. Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001;17(3):457–vi.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fink R. Pain assessment: the cornerstone to optimal pain management. Proc (Bayl Univ Med Cent). 2000;13:236–9.

    Article  CAS  Google Scholar 

  7. Decosterd I, Hugli O, Tamches E, Blanc C, Mouhsine E, Givel JC, et al. Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain. Ann Emerg Med. 2007;50(4):462–71.

    Article  PubMed  Google Scholar 

  8. Marco CA, Kanitz W, Jolly M. Pain scores among emergency department (ED) patients: comparison by ED diagnosis. J Emerg Med. 2013;44(1):46–52.

    Article  PubMed  Google Scholar 

  9. Ketorolac: LexiComp Online; 2017. Available from: http://online.lexi.com/lco/action/doc/retrieve/docid/chiden_f/2948008.

  10. Acute postoperative pain: Lexicomp Online; 2017. Available from: http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/5257.

  11. Litvak KM, McEvoy GK. Ketorolac, an injectable nonnarcotic analgesic. Clin Pharm. 1990;9(12):921–35.

    CAS  PubMed  Google Scholar 

  12. Hernandez-Diaz S, Garcia-Rodriguez LA. Epidemiologic assessment of the safety of conventional nonsteroidal anti-inflammatory drugs. Am J Med. 2001;110(Suppl 3A):20s–7s.

    Article  CAS  PubMed  Google Scholar 

  13. Geusens P, Emans PJ, de Jong JJ, van den Bergh J. NSAIDs and fracture healing. Curr Opin Rheumatol. 2013;25(4):524–31.

    Article  CAS  PubMed  Google Scholar 

  14. Marquez-Lara A, Hutchinson ID, Nuñez F Jr, Smith TL, Miller AN. Nonsteroidal Anti-Inflammatory Drugs and Bone-Healing: A Systematic Review of Research Quality. JBJS Rev. 2016;4(3).

    Google Scholar 

  15. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280(21):1837–42.

    Article  CAS  PubMed  Google Scholar 

  16. Tassone DM, Boyce E, Guyer J, Nuzum D. Pregabalin: a novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther. 2007;29(1):26–48.

    Article  CAS  PubMed  Google Scholar 

  17. Smith HS. Opioid metabolism. Mayo Clin Proc. 2009;84:613–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Patanwala AE, Duby J, Waters D, Erstad BL. Opioid conversions in acute care. Ann Pharmacother. 2007;41(2):255–66.

    Article  CAS  PubMed  Google Scholar 

  19. Huxtable CA, Roberts LJ, Somogyi AA, MacIntyre PE. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011;39(5):804–23.

    Article  CAS  PubMed  Google Scholar 

  20. Fields HL. The Doctor's dilemma: opiate analgesics and chronic pain. Neuron. 2011;69(4):591–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Morphine, Hydromorphone, Fentanyl, Oxycodone, Hydrocodone, Codeine, Tramadol: LexiComp Online; 2017. Available from: http://online.lexi.com.

  22. Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther. 2002;9(1):53–68.

    Article  PubMed  Google Scholar 

  23. Narcotic analgesics comparison: LexiComp Online; 2017. Available from: http://online.lexi.com/lco/action/doc/retrieve/docid/chiden_f/73991.

  24. Hewitt DJ, Todd KH, Xiang J, Jordan DM, Rosenthal NR. Tramadol/acetaminophen or hydrocodone/acetaminophen for the treatment of ankle sprain: a randomized, placebo-controlled trial. Ann Emerg Med. 2007;49(4):468–80, 80.e1–2

    Article  PubMed  Google Scholar 

  25. Dowell D, Haegerich T, Chou R. CDC guideline for prescribing opioids for chronic pain- United States. JAMA. 2016;15:1624–45.

    Article  CAS  Google Scholar 

  26. Lexicomp Online 2017. Available from: http://online.lexi.com/lco/action/doc/retrieve/docid/chiden_f/73620.

  27. Williams DJ, Walker JD. A nomogram for calculating the maximum dose of local anaesthetic. Anaesthesia. 2014;69(8):847–53.

    Article  CAS  PubMed  Google Scholar 

  28. Lidocaine (Systemic) Lexicomp Online: Wolters Kluwer; 3/31/17. Available from: http://online.lexi.com.

  29. Bupivacaine Lexicomp Online: Wolters Klower; 2017. Available from: http://online.lexi.com.

  30. Prilocaine Lexicomp Online: Wolters Klower; 2/27/17. Available from: http://online.lexi.com.

  31. Ropivacaine. Lexicomp Online: Walters Klower; 4/12/17.

    Google Scholar 

  32. McGee D, Roberts J. Anesthetic and Analgesic Techniques. In: Roberts & Hedges’ clinical procedures in emergency medicine. 6th ed. Philadelphia: Elsevier Health Sciences; 2014.

    Google Scholar 

  33. Ohmura S, Ohta T, Yamamoto K, Kobayashi T. A comparison of the effects of propofol and sevoflurane on the systemic toxicity of intravenous bupivacaine in rats. Anesth Analg. 1999;88(1):155–9.

    CAS  PubMed  Google Scholar 

  34. Weinberg GL. Treatment of local anesthetic systemic toxicity (LAST). Reg Anesth Pain Med. 2010;35(2):188–93.

    Article  CAS  PubMed  Google Scholar 

  35. NYSORA – The New York School of Regional Anesthesia – Interscalene Brachial Plexus Block; 2017. Available from: http://www.nysora.com/techniques/nerve-stimulator-and-surface-based-ra-techniques/upper-extremitya/3346-interscalene-brachial-plexus-block.html.

  36. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34(2):134–70.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Blaivas M, Adhikari S, Lander L. A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department. Acad Emerg Med. 2011;18(9):922–7.

    Article  PubMed  Google Scholar 

  38. Liu SS, Zayas VM, Gordon MA, Beathe JC, Maalouf DB, Paroli L, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009;109(1):265–71.

    Article  PubMed  Google Scholar 

  39. Davis JJ, Swenson JD, Greis PE, Burks RT, Tashjian RZ. Interscalene block for postoperative analgesia using only ultrasound guidance: the outcome in 200 patients. J Clin Anesth. 2009;21(4):272–7.

    Article  PubMed  Google Scholar 

  40. NYSORA – The New York School of Regional Anesthesia – Ultrasound-Guided Forearm Block; 2017. Available from: http://www.nysora.com/techniques/ultrasound-guided-techniques/upper-extremity/3066-ultrasound-guided-forearm-block.html.

  41. NYSORA – The New York School of Regional Anesthesia – Ultrasound-Guided Wrist Block; 2017. Available from: http://www.nysora.com/techniques/ultrasound-guided-techniques/upper-extremity/3067-ultrasound-guided-wrist-block.html.

  42. Sohoni A, Herring, A., Stone, M., Nagdev, A. Focus On: Ultrasound-Guided Forearm Nerve Blocks // ACEP: ACEP News; 2017. Available from: https://www.acep.org/Content.aspx?id=82259.

  43. Liebmann O, Price D, Mills C, Gardner R, Wang R, Wilson S, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48(5):558–62.

    Article  PubMed  Google Scholar 

  44. Lynch MT, Syverud SA, Schwab RA, Jenkins JM, Edlich R. Comparison of intraoral and percutaneous approaches for infraorbital nerve block. Acad Emerg Med. 1994;1(6):514–9.

    Article  CAS  PubMed  Google Scholar 

  45. Fishman I, Solano JJ. Mental nerve. Specialty eds; Windle ML, Luis M Lovato LM. Chief Eds; Raghavendra (Raghu) M. Updated: Jan 16, 2019. Accessed on January 7, 2020. https://emedicine.medscape.com/article/82603-overview.

  46. Syverud SA, Jenkins JM, Schwab RA, Lynch MT, Knoop K, Trott A. A comparative study of the percutaneous versus intraoral technique for mental nerve block. Acad Emerg Med. 1994;1(6):509–13.

    Article  CAS  PubMed  Google Scholar 

  47. Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, et al. Randomised trial of the fascia iliaca block versus the '3-in-1′ block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32(9):685–9.

    Article  PubMed  Google Scholar 

  48. NYSORA – The New York School of Regional Anesthesia – Ultrasound-guided fascia iliaca block; 2017. Available from: http://www.nysora.com/updates/3107-ultrasound-guided-fascia-iliaca-block.html.

  49. Dolan J, Williams A, Murney E, Smith M, Kenny GN. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Reg Anesth Pain Med. 2008;33(6):526–31.

    PubMed  Google Scholar 

  50. Ritcey B, Pageau P, Woo MY, Perry JJ. Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review. CJEM. 2016;18(1):37–47.

    Article  PubMed  Google Scholar 

  51. Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003;41(2):227–33.

    Article  PubMed  Google Scholar 

  52. Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010;11:310–3.

    PubMed  PubMed Central  Google Scholar 

  53. Spektor M, Kelly J. Nerve blocks of the thorax and extremities. In: Roberts and Hedges’ clinical procedures in emergency medicine. 6th ed. Philadelphia: Saunders; 2014.

    Google Scholar 

  54. Andrew A. Herring MD, Jacob Miss MD, and Arun D. Nagdev. Ultrasound-Guided Posterior Tibial Nerve Block – ACEP Now. 2017.

    Google Scholar 

  55. Handoll HH, Madhok R, Dodds C. Anaesthesia for treating distal radial fracture in adults. Cochrane Database Syst Rev. 2002;(3):Cd003320.

    Google Scholar 

  56. McGee D. Local and topical anesthesia. In: Roberts and Hedges’ Clinical procedures in emergency medicine. 6th ed. Philadelphia: Saunders; 2014.

    Google Scholar 

  57. Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310–2.

    Article  PubMed  Google Scholar 

  58. Jiang N, Hu YJ, Zhang KR, Zhang S, Bin Y. Intra-articular lidocaine versus intravenous analgesia and sedation for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis. J Clin Anesth. 2014;26(5):350–9.

    Article  CAS  PubMed  Google Scholar 

  59. Wakai A, O’Sullivan R, McCabe A. Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults. Cochrane Database Syst Rev. 2011;(4):Cd004919.

    Google Scholar 

  60. Fitch RW, Kuhn JE. Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review. Acad Emerg Med. 2008;15(8):703–8.

    Article  PubMed  Google Scholar 

  61. Dhinakharan S, Ghosh A. Intra-articular lidocaine for acute anterior shoulder dislocation reduction. Emerg Med J. 2002;19(2):142–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Yari M, Saeb M, Golfam P, Makhloogh Z. Analgesic efficacy of intra-articular morphine after arthroscopic knee surgery in sport injury patients. J Inj Violence Res. 2013;5(2):84–8.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Arti H, Mehdinasab SA. The comparison effects of intra-articular injection of different opioids on postoperative pain relieve after arthroscopic anterior cruciate ligament reconstruction: A randomized clinical trial study. J Res Med Sci. 2011;16:1176–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;45(2):177–96.

    Article  PubMed  Google Scholar 

  65. Gross JB, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.

    Article  Google Scholar 

  66. Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014;63(2):247–58.e18.

    Article  PubMed  Google Scholar 

  67. Eberhart LH, Arndt C, Aust HJ, Kranke P, Zoremba M, Morin A. A simplified risk score to predict difficult intubation: development and prospective evaluation in 3763 patients. Eur J Anaesthesiol. 2010;27(11):935–40.

    Article  PubMed  Google Scholar 

  68. Safavi M, Honarmand A, Amoushahi M. Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD. Adv Biomed Res. 2014;3:133.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Soyuncu S, Eken C, Cete Y, Bektas F, Akcimen M. Determination of difficult intubation in the ED. Am J Emerg Med. 2009;27(8):905–10.

    Article  PubMed  Google Scholar 

  70. Ambesh SP, Singh N, Rao PB, Gupta D, Singh PK, Singh U. A combination of the modified Mallampati score, thyromental distance, anatomical abnormality, and cervical mobility (M-TAC) predicts difficult laryngoscopy better than Mallampati classification. Acta Anaesthesiol Taiwanica. 2013;51(2):58–62.

    Article  Google Scholar 

  71. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–34.

    Article  CAS  PubMed  Google Scholar 

  72. Rosenberg MB, Phero JC. Airway assessment for office sedation/anesthesia. Anesth Prog. 2015;62(2):74–80.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Newman DH, Azer MM, Pitetti RD, Singh S. When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1367 pediatric procedural sedations. Ann Emerg Med. 2003;42(5):627–35.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Alexander Ebinger

  2. Department of Emergency Medicine and Orthopedics, Denver Health Medical Center, Denver, CO, USA

    Spencer Tomberg

Authors
  1. Alexander Ebinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Spencer Tomberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Ebinger .

Editor information

Editors and Affiliations

  1. Department of Family Medicine and Orthopedics, University of Colorado School of Medicine, Denver, CO, USA

    Morteza Khodaee

  2. Department of Emergency and Sports Medicine, The University of Arizona, Tucson, AZ, USA

    Anna L. Waterbrook

  3. Vermont Orthopedic Clinic, Rutland, VT, USA

    Matthew Gammons

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ebinger, A., Tomberg, S. (2020). Anesthesia and Acute Pain. In: Khodaee, M., Waterbrook, A., Gammons, M. (eds) Sports-related Fractures, Dislocations and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36790-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36790-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-36789-3

  • Online ISBN: 978-3-030-36790-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation