Analgesia in Chest Trauma

OVERVIEW

• chest trauma is very painful as rest is not possible, pain is experienced with every breath
• a multi-modal approach ideal with MDT involvement (ICU, anaesthesia and pain)

PRINCIPLES

Effective analgesia important to decreased incidence of complications:

• atelectasis
• pneumonia
• respiratory failure and mechanical ventilation
• MI

Analgesic techniques depends on these factors:

• type of injury
• interventions performed  (e.g. drains, thoracotomy)
• allergies and adverse reactions
• co-morbid conditions (COPD)
• type of pain (somatic, neuropathic)
• associated injuries
• pre-existing chronic pain issues and tolerance

Analgesia needs to be adequate so patient can cough effectively and participate with physiotherapy

SPECIFIC THERAPIES

multimodal approach

• pharmacological
• physical
• procedural
• psychosocial

simple analgesics

• paracetamol, NSAIDs if not contraindicated – bleeding, renal impairment, gastric prophylaxis

Opioid analgesia

• tramadol (avoid if risk of seizures or serotonin syndrome)
• morphine
• fentanyl
• may require a PCA or infusion if ventilated

analgesic adjuncts

• alpha blockers — clonidine, demedetomidine
• neuropathic agents — gabapentin, amitryptilline
• ketamine
• lignocaine infusions

regional analgesia

• intercostal catheters
• paravertebral catheter
• thoracic epidural