Pain Management in Chest Trauma

Abstract

Patients continue to report inadequate or poor pain control in the hospital setting following thoracic trauma. Moderate-to-severe pain is a potent activator of the “stress response”. Ongoing stimulation of this response can have a detrimental effect on many physiologic functions. Cardiovascular, pulmonary, gastrointestinal, and hemostatic functions may all be negatively affected by poorly controlled pain. Postoperative pain due to elective surgery is often used as a model for thoracic trauma pain management. This approach has limitations. Trauma pain is experienced without the benefits of anesthesia or preemptive analgesia. Thoracic trauma pain management seeks to limit the secondary effects of an initially painful stimulus. Resuscitation and neurological assessment may delay definitive pain control. A multimodal approach to the management of thoracic trauma pain may include combinations of systemic narcotics, nonsteroidal anti-inflammatory medications, epidural narcotics, epidural local anesthetic combinations, pleural catheters as well as peripheral nerve blocks. Carefully titrated systemic narcotics continue to be the most commonly applied pain management treatment either by fixed dosing or patient controlled techniques. This treatment approach alone often does not provide adequate pain control and is not without unwanted adverse effects. When appropriate, the addition of regional analgesic techniques can improve patient satisfaction, attenuate the detrimental stress response, and lead to improved patient outcome. An individualized, physician-derived pain management plan is required in order to provide adequate pain management to the thoracic trauma patient.