Treatment of pain in trauma patients with injuries of the upper limb

Since preoperative pain therapy of a trauma patient did not play an outstan ding role in the past, this article shall give information about the adequa te treatment of such patients, which can be mainly divided into three phase s: the prehospitalisation phase with stabilisation of the trauma patient, t he early phase of hospitalisation with further stabilisation, diagnosis and surgery, and finally the postoperative phase with corresponding treatment. An optimal analgesic in the prehospitalisation phase should guarantee good analgesic effects, rapid onset and good controllability, simple handling an d the opportunity to combine it with other medication. In addition, it shou ld prevent a wide therapeutic range and the absence of side effects. Opioids and ketamine are available for acute pain therapy after trauma. The main opioids used are piritramide and pethidine, with piritramide acting a s a sedative at the same time and with pethidine preventing the stronger an algesic effect. The intravenous use of ketamine has become established in t rauma patients because of its excellent analgesia at subanaesthetic doses. Especially in multiple trauma patients, the indication for general anaesthe sia with intubation should be established on a liberal basis. Nevertheless, for some patterns of injury regional techniques may be advantageous; there fore, this article describes the possible regional procedures (such as intr avenous regional anaesthesia or block of peripheral nerves). Concerning the postoperative phase, an individual pain management can be guaranteed by sy stemic pharmacotherapy and regional catheter techniques, for example the br achial plexus blockade that results in a long period of free pain. (C) 2000 Elsevier Science Ltd. All rights reserved.