tailieunhanh - Emergency trauma pain management in critical care: Part 2

(BQ) Continued part 1, part 2 of the document Emergency trauma pain management in critical care has contents: Regional techniques and epidural analgesia for pain relief in critical care, managing pain in the patient suffering trauma, managing pain in special patient populations,. and other contents. Invite you to refer. | 13 Regional Techniques and Epidural Analgesia for Pain Relief in Critical Care EPIDURAL BASICS Epidural pain management can provide the largest amount of pain relief with the least amount of medication. This is because equianalgesi-cally the doses of opioids delivered to the epidural and intrathecal spaces are several times more potent than the same medications given intravenously. Adding a local anesthetic such as bupivacaine or ropivacaine to the epidural solution creates a synergistic effect that enhances the overall analgesic effect of the epidural. For patient in critical care areas the use of epidurals can provide excellent pain relief with less opioid than usually required. It can allow the patient with a thoracotomy or flail chest to cough and deep breathe more effectively and for other patients increase mobility. Trauma patients can benefit greatly from the use of an epidural or other regional technique in order to control pain that can last for several weeks at high intensity levels. In most cases the epidural is placed perioperatively and either used during surgery as an alternate to general anesthesia but also as postoperative analgesia. The opioid medications used for epidural pain management bind to opioid receptors in the dorsal horn of the spinal cord and can produce effective analgesia at greatly reduced doses. The addition of local anesthetic allows the nerve roots closest to the placement site to be bathed in the epidural solution causing localized pain relief. In most cases epidurals used for postoperative pain relief have solutions that contain both low dose opioids and local anesthetic. Some patients are resistant to epidural catheters fearing that they will have a needle in their backs during the entire time of infusion. Patients should be reassured that the needle is only used for placing the catheter and the tubing that remains is very small and soft. 171 172 13. Regional Techniques and Epidural Analgesia for Pain Relief Patients who are .