What does analgesia mask?

Lejus, C.

doi:10.1111/j.1460-9592.2004.01399.x

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Case reports attributed the delayed diagnosis of compartment syndrome to postoperative epidural anaesthesia [53], PNB and patient controlled analgesia [54]. We suggest that it is safe to use analgesics in such trauma cases, but advocate caution.…”

Section: Safety and Complications Of Pain Management In The Trauma Pamentioning

confidence: 88%

Pain management and regional anaesthesia in the trauma patient

Davidson

Ginosar

Avidan

2005

Current Opinion in Anaesthesiology

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Educating the emergency room staff to perform early routine assessment of pain and to be familiar with the administration of analgesia are key elements to improved pain management in trauma. Peripheral nerve block techniques should be practised by emergency room staff. If simple techniques are chosen, competence can be achieved with short, focused training sessions. Further developments are needed in order to provide safer and more effective analgesia to the trauma patient.

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Section: Safety and Complications Of Pain Management In The Trauma Pamentioning

confidence: 88%

Pain management and regional anaesthesia in the trauma patient

Davidson

Ginosar

Avidan

2005

Current Opinion in Anaesthesiology

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“…It has also been used for pain associated with trauma, oncological conditions, palliative care and some medical conditions 8 . The use of PCA and regional anaesthesia techniques have been implicated in the development of CS in adults due to masking of early symptoms of severe pain [9][10][11][12][13][14][15][16] . Several of these papers report the possibility of PCA delaying the diagnosis of CS 9,11,12 and the authors conclude that PCA is potentially hazardous in those patients considered at high risk for development of CS.…”

Section: Discussionmentioning

confidence: 99%

“…Several paediatric cases of CS with use of regional anaesthesia for analgesia have been reported 13,[15][16][17] . However, a recent review of epidural analgesia for lower limb surgery in children showed no clear evidence that presence of an epidural delayed the diagnosis of CS 18 .…”

Section: Discussionmentioning

confidence: 99%

Compartment Syndrome and Patient-Controlled Analgesia in Children – Analgesic Complication or Early Warning System?

Yang

Cooper

2010

Anaesth Intensive Care

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We present two cases of children who developed compartment syndrome after upper limb fractures. Morphine patient-controlled analgesia was used in a bolus-only mode for analgesia (bolus 20 μg/kg, five minute lockout and hourly limit of 150 μg/kg). An increase in patient-controlled analgesia use was observed up to 12 hours before the decision was made to proceed to fasciotomy but neither child exceeded the hourly limit or had an excessive increase in pain scores. Clinical risk factors for compartment syndrome should be identified and appropriate monitoring instituted. A subtle increase in patient-controlled analgesia use may be an early indicator of impending compartment syndrome before classical signs such as reporting of pain, pallor, paraesthesiae, paralysis and pulselessness develop. These cases and review of the literature suggest techniques which may assist earlier diagnosis of compartment syndrome include setting a more conservative hourly limit of morphine patient-controlled analgesia such as 80 to 100 μg/kg/hour and graphing of patient-controlled analgesia demands and boluses, pain scores at rest and pain scores with passive flexion and extension of digits. These practices could identify trends that pain or analgesia requirement is increasing leading to earlier diagnosis of compartment syndrome.

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“…This position is not acceptable for both medical and ethical reasons [50]. Intense pain is a constant symptom associated with fractures, whether or not a compartment syndrome is developing.…”

Section: Patient Care and Medico-legal Implicationsmentioning

confidence: 99%

Some current controversies in paediatric regional anaesthesia

Dalens

2006

Current Opinion in Anaesthesiology

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The performance of regional blocks in anaesthetized patients is generally contra-indicated in adults but accepted in children. Levobupivacaine displays the same pharmacokinetic profile as racemic bupivacaine with possibly less cardiac toxicity. Ropivacaine undergoes slower absorption and, in some studies, concomitant increase in peak plasma concentration in infants. Conversely, continuous infusion of ropivacaine offers the safest therapeutic index. Many adjuvants have been used but only epinephrine, clonidine, and preservative-free ketamine offer clear advantages. Midazolam and neostigmine are effective but have potential drawbacks and raise safety questions. Needle and catheter positioning is critical. Electrocardiogram guidance and electrical stimulation occasionally help identify the migration of epidural catheters. Stimulating catheters might be useful for continuous peripheral blockade. Ultrasonography will probably become the reference technique for peripheral catheter placement. Patients at risk of compartment syndrome must be monitored (measurement of compartmental pressures); adequate pain management does not 'hide' this complication but, on the contrary, can facilitate early diagnosis since the increase in requirement for pain medication precedes other clinical symptoms by an average of 7.3 h.

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What does analgesia mask?

Cited by 4 publications

References 22 publications

Pain management and regional anaesthesia in the trauma patient

Pain management and regional anaesthesia in the trauma patient

Compartment Syndrome and Patient-Controlled Analgesia in Children – Analgesic Complication or Early Warning System?

Some current controversies in paediatric regional anaesthesia

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