Page 127 Guide to Pain Management in Low-Resource Settings

Chapter 15

Acute Trauma and Preoperative Pain

O. Aisuodionoe-Shadrach

When acute trauma occurs, the diagnosis and purposeful ries that may pose a potential danger to life besides the
management of pain should be of paramount concern. obvious left ankle injury.
Intravenous access is obtained for the admin-
Case report istration of fl uids and/or medications, and Dr Omoy-
emen then performs a thorough evaluation of the pa-
A 38-year-old man, John Bakor, is brought to the ac- tient’s pain using a standardized assessment tool, the
cident and emergency room after being knocked down verbal rating scale (VRS). John’s VRS = 7/10, suggesting
by a small vehicle. He was transported in the back seat that he is having acute severe pain. Th e doctor admin-
of a saloon car without any splint to his injured leg isters 50 mg of pethidine (meperidine) intramuscularly
and had jolts of pain every time the car stopped on its (i.m.) as a preliminary analgesic before the injury is
bumpy ride to the hospital. formally reviewed and dressings are changed, and i.m.
John is received by Dr Omoyemen, the attend- tetanus toxoid is administered to prevent tetanus.
ing resident, who after putting a full-length aluminium After dressings are complete, adequate regular
gully-splint to immobilize his left lower limb, asks for analgesia is commenced (pethidine 50 mg i.m., 6-hour-
a helping hand to move him onto a hospital stretcher. ly). Finally, while John is awaiting formal orthopedic
Fracture immobilization on its own minimizes pain surgical review, his pain is reassessed regularly to deter-
due to the fracture injury by limiting movement of the mine the eff ectiveness of the analgesic regimen, which is
aff ected parts. A quick review reveals that John had also periodically reviewed as required.
sustained an open fracture with dislocation of the left
ankle and has multiple skin bruises over his left fore- Questions you should ask yourself
arm and thigh. He is fully conscious, knows who he is, and their probable answers
and is well oriented as to time and place. He is then
checked for other injuries that he may have ignored as What is pain?
inconsequential or may be unaware of, such as other Acute pain results from tissue damage, which can be
bruises or lacerations. Dr Omoyemen obtains a brief caused by an infection, injury, or the progression of a
history of the nature of the accident and proceeds to metabolic dysfunction or a degenerative condition.
specifi cally evaluate for secondary injuries such as Acute pain tends to improve as the tissues heal and
blunt abdominal injuries, or chest wall or pelvic frac- responds well to analgesics and other pain treatments.
tures. Th e benefi t of this evaluation is to identify inju- We know that pain is a subjective sensation, although
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 115
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.