ANALGESICS, ANESTHETICS AND TRAUMA

By Tristan Saggese

OVERVIEW

•How and What? •Policy: Prehospital Pain Management Protocol •People: Quality of Life Study•Practice: Morphine and Ketamine Study

ANESTHETICS

•Pain control and •Types of Anesthetics: •Local, Regional, General

ANALGESICS

•Pain Relief •Opioids •NSAIDS

POLICY

THE STUDY

•Variable pre-hospital pain protocol•2013, Maryland Institute for Emergency Medical Services Systems•Purpose: Assess implementation of prehospital pain management protocol and recommend revisions

METHODS

•The National Prehospital EBG Model Process•Reviewed by MIEMSS Protocol Review Committee •The review looked at 1,638 pre- implementation EMS cases and 1,853 during post-implementation • 12 Month periods

RESULTS

Pre- implementation

Post- implementation

RESULTS

RESULTS

CONCLUSIONS

•Review process and Guidelines led to improved hospital care •Changes in dosage and repeat dosing•Failure to treat pain with anesthetics

PEOPLE:

•Opioids:

THE STUDY

•2013, Monash University, Alfred Center in Melbourne•Long term follow up in trauma patients•Analyze persisting pain levels

METHODS

• 136 participants; between December 2007 and July 2010• 20 minute phone surveys • The Short Form 36 V.2 Health Survey (PMC / MCS) • Global pain numerical rating score

DATA

RESULTS

RESULTS

CONCLUSIONS

•Variable protocol in trauma patients pain management / treatment•Long-term Evaluation of acute pain management

PRACTICE

THE STUDY

•2015, Emergency Department of Lille University Hospital •Assess continuous infusion of Ketamine

METHODS

•Continuous infusion of Ketamine (IK) versus Saline (IS)•Assessed Visual Analogic Scale (VAS)

DATAIK group (n = 30)

IS group (n = 30)

RESULTS

RESULTS

CONCLUSION

•Short duration of pre-hospital emergency care •Benefit of co-analgesic associations were not supported • Increase in adverse effects with Ketamine?

FINAL THOUGHTS

•Pain management protocol is still widely variable•Further studies should elucidate guiding protocol.

REFERENCES

• "Analgesics." TheFreeDictionary.com. N.p., n.d. Web. 02 May 2016.• Brown, Kathleen M., Jon Mark Hirshon, Richard Alcorta, Tasmeen S. Weik, Ben Lawner, Shiu Ho,

and Joseph L. Wright. "The Implementation and Evaluation of an Evidence-based Statewide Prehospital Pain Management Protocol Developed Using the National Prehospital Evidence-based Guideline Model Process for Emergency Medical Services." Prehospital Emergency Care18.Sup1 (2013): 45-51. Web. 2 May 2016.

• How Does Anesthesia Work?" Scientific American. N.p., 2005. Web. 04 May 2016.• Jennings, Paul A. "Long-term Pain Prevalence and Health-related Quality of Life Outcomes for

Patients Enrolled in a Ketamine versus Morphine for Prehospital Traumatic Pain Randomised Controlled Trial." Long-term Pain Prevalence and Health-related Quality of Life Outcomes for Patients Enrolled in a Ketamine versus Morphine for Prehospital Traumatic Pain Randomised Controlled Trial. Emergency Medical Journal, 13 July 13 july 2013. Web. 04 May 2016.

• Cohen, SP. "Pain Management in Trauma Patients : American Journal of Physical Medicine & Rehabilitation." LWW. N.p., Feb. 2004. Web. 05 May 2016.

• Wiel, Eric, Djamel Zitouni, Nathalie Assez, Quentin Sebilleau, Sébastien Lys, Audrey Duval, Patrick Mauriaucourt, and Hervé Hubert. "Continuous Infusion of Ketamine for Out-of-hospital Isolated Orthopedic Injuries Secondary to Trauma: A Randomized Controlled Trial." Prehospital Emergency Care 19.1 (2014): 10-16. Web. 1 May 2016.