Department of Anesthesiology, Stanford University School of Medicine, USA.
Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St., Mailcode 6342, Redwood City, CA, 94063, USA.
Injury. 2020 May;51 Suppl 2:S28-S36. doi: 10.1016/j.injury.2019.04.008. Epub 2019 Apr 25.
When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.
在治疗骨科创伤患者的疼痛时，阿片类药物一直是主要的治疗方法。它们相对便宜，对基本的疼痛管理也有一定的效果。然而，它们存在着相当多的副作用，以及非常高的成瘾风险。它们在疼痛管理中的应用与阿片类药物流行有关。出于这个原因，以及它们只有中等的疗效，人们一直在寻找替代的治疗方法，既用于孤立肢体创伤的患者，也用于多发性创伤的患者。我们回顾了孤立肢体创伤和多发性创伤患者疼痛管理中的替代治疗方法。这些方法包括局部制剂，以及非甾体抗炎药、对乙酰氨基酚、加巴喷丁类药物、静脉制剂、不同程度的局部麻醉浸润和周围神经阻滞，以及新的筋膜平面阻滞。通常，这些镇痛方法的组合为创伤患者提供了最佳的治疗效果。这也往往需要根据患者的个体情况进行定制，因为没有两个患者在这方面的表现完全相同。因此，管理此类患者疼痛的医生必须具备丰富的经验，精通所有这些治疗方法。我们还提供了一个基本的分步算法，我们发现它在治疗单肢或单部位创伤患者与多发性创伤患者及其多部位疼痛源方面非常有用。希望这种对不同方法的分解，以及对每种方法潜在益处和适应证的更好理解，将有助于外科医生为骨科创伤患者提供更好的护理。
