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Acute Situations: Trauma in Surgical Specialties

  • Sandra Giannone
  • Daniela Ghisi
  • Andrea Fanelli
  • Carl C. Rest
Chapter

Abstract

Pain is the most common symptom reported by trauma patients entering the Emergency Department. Treatment has a crucial role in trauma, since adequate pain management leads not only to increased patient comfort and satisfaction, but also to reduced morbidity (such as pulmonary complications or thromboembolic events), shorter length of stay, and improved long-term outcomes. Unfortunately, multiple studies have reported that trauma-related pain is still inadequately controlled. Loco-regional anesthesia, e.g., peripheral nerve blocks, is emerging as an important technique that can be applied at the patient admission to the Emergency Department, and maintained through the perioperative setting. Regional anesthesia can become the first choice of analgesia in patients with isolated orthopedic injuries and burning injuries because this technique is devoid of many adverse effects associated with systemic opioids. Brachial plexus blocks can provide excellent analgesia for upper extremity trauma; lumbar plexus block and sciatic nerve block, both performed at different sites, can be used for lower extremity fractures, while epidural, paravertebral, intercostal, and interpleural block can provide analgesia for thoracic trauma. Some peculiar features of the trauma patients, such as acute blood loss, trauma associated coagulopathy, and the threat of compartment syndrome, must be kept in mind and pose an extra challenge to the choice of the optimal pain management technique.

Keywords

Trauma Pain management Nerve block Humeral fractures Shoulder fractures Hip fractures Femoral fractures Compartment syndromes Brachial plexus block Lumbosacral plexus Rib fractures Analgesia Epidural Paravertebral block Intercostal nerve block Interpleural analgesia 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sandra Giannone
    • 1
  • Daniela Ghisi
    • 1
  • Andrea Fanelli
    • 2
  • Carl C. Rest
    • 3
  1. 1.Department of Anesthesia, Intensive Care and Pain ManagementRizzoli Orthopedic InstituteBolognaItaly
  2. 2.Department of Anesthesiology and Pain ManagementPoliclinico Sant’Orsola-MalpighiBolognaItaly
  3. 3.Department of Anesthesia and AIPPSUniversity of Pittsburgh Medical CenterPittsburghUSA

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