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34 - Pharmacologic Management of Acute Pain in Trauma

Published online by Cambridge University Press:  18 January 2010

By
Shalini Dhir ,
Veerabadran Velayutham  and
Sugantha Ganapathy
Edited by
Charles E. Smith
Shalini Dhir
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Veerabadran Velayutham
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Sugantha Ganapathy
Affiliation:
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Evaluate pain management modalities in the acutely injured patient.

  2. Review the pharmacology of acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs, opioids, tramadol, local anesthetics, and ketamine in trauma patients.

  3. Discuss the role of antidepressants, anticonvulsants, benzodiazepines, alpha 2 agonists, and entonox for acute pain in trauma.

  4. Discuss the role of multimodal analgesia for trauma patients.

INTRODUCTION

The widely accepted definition of pain was developed by a taxonomy task force of the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms” [1]. Managing pain can be challenging in most scenarios and providing adequate pain relief forms a vital part in the initial management of trauma. Inadequate analgesia in acute situations can have deleterious effects on the immune system, healing process, and autonomic activity and can lead to the development of a chronic pain state (see Chapter 35).

PATHOPHYSIOLOGY OF STRESS RESPONSE TO INJURY AND PAIN

Pain is a protective response. This reflex response has an effect on multiple systems in the body. These include exaggerated stress response, sleep deprivation, altered glucose homeostasis, increased sympathetic nervous system activation, and altered gastrointestinal, renal, and endocrine function. The stress response produced has effects on various organ systems additionally such as cardiovascular, immune, endocrine, and respiratory systems. Thus, the stress response to injury is a complex hormonal and neurologic phenomenon. In a trauma patient, the consequences of this response are multifactorial.

Type
Chapter
Information
Trauma Anesthesia , pp. 528 - 543
Publisher: Cambridge University Press
Print publication year: 2008

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References

Taxonomy of pain syndromes. In Charlton, JE, ed. Core Curriculum for Professional Education in Pain. Seattle: IASP Press, 2005.Google Scholar
Silka, PA, Roth, MM, Moreno, G, Merrill, L, Geiderman, JM. Pain scores improve analgesic administration patterns for trauma patients in the emergency department. Acad Emerg Med 2004; 11(3):264–70.CrossRefGoogle ScholarPubMed
Kelly, AM. A process approach to improving pain management in the emergency department: development and evaluation. J Accid Emerg Med 2000; 17: 185–7.CrossRefGoogle ScholarPubMed
AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50(6 Suppl):S205–24.CrossRef
Flower, RJ, Vane, JR. Inhibition of prostaglandins synthetase in brain explains the antipyretic activity of paracetamol (4-acetamidophenol). Nature 1972; 240:–1.CrossRefGoogle Scholar
Chandrasekharan, NV, Hu, Dai, Roos, KLT, Evanson, NK, Tomsik, J, Elton, TS, Simmons, DL. COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure and expression. Proc Natl Acad Sci USA 2002; 99(21):13926–31.CrossRefGoogle ScholarPubMed
Lucas, R, Warner, TD, Vojnovic, I, Mitchell, JA. Cellular mechanisms of acetaminophen: role of cyclo-oxygenase. FASEB J 2005; 19: 635–7.CrossRefGoogle ScholarPubMed
Herrero, JF, Headly, PM. Reversal by naloxone of the spinal antinociceptive actions of a systemically administered NSAIDs. Br J Pharmacol 1996; 118: 968–72.CrossRefGoogle Scholar
Sandrini, M, Romualdi, P, Vitale, G et al. The effect of a paracetamol and morphine combination on dynorphin A levels in the rat brain. Biochem Pharmacol 2001; 61: 1409–16.CrossRefGoogle ScholarPubMed
Bujalska, M. Effect of non-selective and selective opioid receptor antagonists on antinociception action of acetaminophen. Pol J Pharma 2004; 56: 539–45.Google Scholar
Bertollini, A, Ferrari, A, Ottani, A, Guerzoni, S, Tacchi, R, Leone, S. Paracetamol: new vistas of an old drug. CNS Drug Rev 2006; 12(3–4):250–75.CrossRefGoogle Scholar
Barden, J, Edwards, J, Moore, A, et al. Single dose oral paracetamol (acetaminophen) for postoperative pain (Cochrane Review). Cochrane Lib 2004; 1: 1–54.Google Scholar
Moller, PL, Sindet-Pedersen, S, Petersen, CT, et al. Onset of acetaminophen analgesia: comparison of oral and intravenous routes after third molar surgery. Br J Anaesth 2005; 94: 642–8.CrossRefGoogle ScholarPubMed
Juhl, GI, Norholt, SE, Tonnesen, E, et al. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2 g starting dose following third moral surgery. Eur J Pain 2006; 10: 371–7.CrossRefGoogle Scholar
Shaikh, N, Kettern, MA, Ahmed, Ali AH, Louon, A. Morphine sparing effect of proparacetamol in surgical and trauma intensive care. Middle East J Emerg Med 2006; 6(2):28–30.Google Scholar
Skoglund, , Skjelbred, P, Fyllingen, G. Analgesic efficacy of acetaminophen 1000 mg, acetaminophen 2000 mg, and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg versus placebo in acute postoperative pain. Pharmacotherapy 1991; 11: 364–9.Google ScholarPubMed
Hahn, TW, Mogensen, T, Lund, C, et al. Analgesic effect of iv paracetamol; possible ceiling effect of paracetamol in postoperative pain. Acta Anaesth Scand 2003; 47(2):138–45.CrossRefGoogle Scholar
Vitols, S. Paracetamol hepatotoxicity at therapeutic doses. J Intern Med 2003; 253: 95–8.CrossRefGoogle ScholarPubMed
Bacon, TH, Hole, JG, North, M, Burnett, I. Analgesic efficacy of sustained release paracetamol in patients with osteoarthritis of the knee. Br J Clin Pharmacol 2002; 53: 629–36.CrossRefGoogle ScholarPubMed
Cormack, CRH, Sudan, S, Anderson, R, Keating, J, Sherwood, RA, Ashley, EMC. The pharmacokinetics of a single rectal dose of paracetamol (40 mg/kg) in children with liver disease. Paediatr Anaesth 2006; 16: 417–23.CrossRefGoogle Scholar
Larson, AM, Polson, J, Fontana, RJ, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005; 102: 822–31.Google Scholar
Moore, PK, Marshall, M. Nitric oxide releasing acetaminophen (nitroactaminophen). Dig Liver Dis 2003; 35(Suppl 2):S49–60.CrossRefGoogle Scholar
Anderson, BJ, Palmer, GM. Recent developments in the pharmacological management of pain in children. Curr Opin Anaesthesiol 2006; 19: 285–92.CrossRefGoogle ScholarPubMed
Watson, DJ, Harper, SE, Zhao, PL, Quan, H, Bolognese, JA, Simon, TJ. Gastrointestinal tolerability of the selective Cyclooxygenase-2 (COX-2) inhibitor rofexoxib compared with nonselective COX-1 and COX-2 inhibitors in osteoarthritis. Arch Intern Med 2000; 160(19):2998–3003.CrossRefGoogle ScholarPubMed
Reuben, SS, Buvanendran, A, Kroin, JS, Stein, RB. Postoperative modulation of central nervous system prostaglandin E2 by cyclooxygenase inhibitors after vascular surgery. Anesthesiology 2006; 104: 411–6.CrossRefGoogle ScholarPubMed
Sinatra, R. Role of COX-2 inhibitors in the evolution of acute pain management. J Pain Symptom Manage 2002; 24: S18–27.CrossRefGoogle ScholarPubMed
Samad, TA, Moore, KA, Sapirstein, A, et al. Interleukin-1 beta-mediated induction of COX-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001; 410: 471–5.CrossRefGoogle Scholar
Buvanendran, A, Kroin, JS, Tuman, KJ, Lubenow, TR, Elmofty, D, Luk, P. Cerebrospinal fluid and plasma pharmacokintetics of the cycloxygenase 2 inhibitor rofecoxib in humans: single and multiple oral drug administration. Anesth Analg 2005; 100: 1320–4.CrossRefGoogle Scholar
Hawkey, CJ, Glitton, X, Hoexter, G, Richard, D, Weinstein, WM. Gastrointestinal tolerability of lumiracoxib in patients with osteoarthritis and rheumatoid arthritis. Clin Gastroenterol Hepatol 2006; 4(1):57–66.CrossRefGoogle ScholarPubMed
Mehallo, CJ, Drezner, JA, Bytomski, JR. Practical management: nonsteroidal antiinflammatory drug (NSAID) use in athletic injuries. Clin J Sport Med 2006; 16: 170–4.CrossRefGoogle ScholarPubMed
Zhang, J, Diang, EL, Song, Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events. JAMA 2006; 296(13): 1619–32.CrossRefGoogle ScholarPubMed
Bannwarth, B. Is licofelone, a dual inhibitor of cyclo-oxygenase and 5-lipoxygenase, a promising alternative in anti-inflammatory therapy?Fundam Clin Pharmacol 2004; 18: 125–30.CrossRefGoogle ScholarPubMed
Rahme, E, Barkun, AN, Toubouti, Y, Scalera, A, Rochon, S, Lelorier, J. Do proton-pump inhibitors confer additional gastrointestinal protection in patients given celecoxib?Arthritis Rheum 2007; 57(5):748–55.CrossRefGoogle ScholarPubMed
Chan, F, Wong, V, Suen, B, et al. Combination of a cyclo-oxygensase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomized trial. Lancet 2007; 369(9573): 1621–6.CrossRefGoogle Scholar
Singh, G, Ramey, Rosen D. NSAID induced gastrointestinal complications: the ARAMIS perspective-1997, Arthritis, Rheumatism and Aging Medical Information System. J Rheumatol Suppl 1998; 51: 8–16.Google ScholarPubMed
Chen, JY, Wu, GJ, Mok, MS, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients – a prospective, randomized, double blind study. Acta Anesth Scand 2005; 49(4):546–51.CrossRefGoogle ScholarPubMed
Stephens, JM, Pashos, CL, Haider, S, Wong, JM. Making progress in the management of postoperative pain: a review of the cyclooxygenase-2 specific inhibitors. Pharmacotherapy 2004; 24(12):1714–31.CrossRefGoogle ScholarPubMed
Mathew, ST, Devi, SG, , KV S. Formulation and evaluation of ketorolac tromethamine-loaded albumin microspheres for potential intramuscular administration. AAPS Pharm Sci Tech 2007; 8(1):14.CrossRefGoogle ScholarPubMed
Chio, JS, Cho, YA, Chun, IK, Jung, SY, Gwak, HS. Formulation and evaluation of ketorolac transdermal systems. Drug Delivery 2007; 14(2):69–74.CrossRefGoogle Scholar
McAleer, SD, Majid, O, Venables, E, Polack, T, Sheikh, MS. Pharmacokinetics and safety of ketorolac following single intranasal and intramuscular administration in healthy volunteers. J Clin Pharmacol 2007; 47(1):13–8.CrossRefGoogle ScholarPubMed
Predel, HG, Koll, R, Pabst, H, et al. Diclofenac patch for topical treatment of acute impact injuries: a randomized, double blind, placebo controlled, multicentre study. Br J Sports Med 2004; 38(3):318–23.CrossRefGoogle ScholarPubMed
Dimar, JR II, Ante, WA, Zhang, YP, Glassman, SD. The effects of nonsteroidal anti-inflammatory drugs on posterior spinal fusion in rat. Spine 1996; 21: 1870–6.CrossRefGoogle Scholar
Reuben, SS, Connelly, NR. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Anesth Analg 2000; 91: 1221–5.Google ScholarPubMed
Radi, ZA, Khan, NK. Effect of cyclooxygenase inhibition on bone, tendon and ligament healing. Inflamm Res 2005; 54: 358–66.CrossRefGoogle Scholar
Cohen, DB, Kawarmura, S, Ehteshami, JR, Rodeo, SA. Indomethacin and celecoxib impair rotator cuff tendon-to-bone healing. Am J Sports Med 2006; 34(3):362–9.CrossRefGoogle ScholarPubMed
Yaksh, TL. Pharmacology and mechanisms of opioid analgesic activity. Acta Anaesthesiol Scand 1997; 41(1pt 2):94–111.CrossRefGoogle ScholarPubMed
Mackersie, RC, Karagianes, TG, Hoyt, DB, et al. Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. J Trauma 1991; 31(4):443–9.CrossRefGoogle ScholarPubMed
EvansE, E,TurleyN, N,RobinsonN, N,Clancy, M. Randomized controlled trial of patient controlled analgesia compared with nurse delivered analgesia in an emergency department. Emerg Med J 2005; 22(1):25–9.CrossRefGoogle Scholar
George, MJ. The site of action of epidurally administered opioids and its relevance to postoperative pain management. Anaesthesia 2006; 61(7):659–64.CrossRefGoogle ScholarPubMed
Dale, O, Hjortkjaer, R, Kharasch, ED. Nasal administration of opioids for pain management in adults. Acta Anaesth Scand 2002; 46(7):759–70.CrossRefGoogle ScholarPubMed
Mercadante, S, Villari, P, Ferrera, P, Casuccio, A, Mangione, S, Intravaia, G. Transmucosal fentanyl vs. intravenous morphine in doses proportional to basal opioid regimen for episodic breakthrough pain. Br J Cancer 2007; 96(12):1828–33.CrossRefGoogle ScholarPubMed
Simpson, DM, Xie, F, Messina, J. Fentanyl buccal tablet (FBT) in the treatment of breakthrough pain in opioid tolerant patients with chronic neuropathic pain: randomized, placebo controlled study. Eur J Pain 2007; 11(1):84.CrossRefGoogle Scholar
Viscusi, ER, Reynolds, L, Chung, F, Atkinson, , Khanna, S. Patient-controlled transdermal fentanyl hydrochloride vs. intravenous morphine pump for postoperative pain. JAMA 2004; 291(11):1333–41.CrossRefGoogle ScholarPubMed
Farr, SJ, Otulana, BA. Pulmonary delivery of opioids as pain therapeutics. Adv Drug Deliv Rev 2006; 58(9–10):1076– 88.CrossRefGoogle ScholarPubMed
Rosseland, L, Solheim, N, Stubhaug, A. Intra-articular morphine in acute pain trials. Reg Anesth Pain Med 2007; 32(2):176–7.CrossRefGoogle ScholarPubMed
Kotwal, RS, O'Connor, KC, Johnson, TR, Mosely, DS, Meyer, , Holcomb, JB. A novel pain management strategy for combat casualty careAnn Emerg Med. 2004; 44(2):121–7.CrossRefGoogle ScholarPubMed
Fulda, GJ, Giberson, F, Fagraeus, L, Angood, PB, Gentilello, LM. A prospective tandomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the managment of acute thoracic pain. J Trauma 2005; 59(2):383–90.CrossRefGoogle Scholar
Ganapathy, S, Choi, PT, Chrisholm, KC, Sutton, I, Chan, VWS. Inhaled liposome-encapsulated fentanyl (AeroLEF) for postoperative pain after orthopedic surgery. Anesthesiology 2006; 105: A1191.Google Scholar
Sinatra, R. The fentanyl HCl patient-controlled transdermal system (PCTS): an alternative to intravenous patient-controlled analgesia in the postoperative setting. Clin Pharmacokinet 2005; 44(Suppl 1):1–6.CrossRefGoogle ScholarPubMed
Stein, C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993; 339: 182–9.Google Scholar
Reuben, SS, Vieira, P, Faruqii, S, Verghis, A, Kilaru, PA, Maciolek, H. Local administration of morphine for analgesia after ilica bone graft harvest. Anesthesiology 2001; 95: 390–4.CrossRefGoogle Scholar
Stein, C, Millan, MJ, Shippenberg, TS, Peter, K, Hertz, A. Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and kappa receptors. J Pharmacol Exp Ther 1989; 248: 1269–75.Google ScholarPubMed
Stein, C, Comisel, K, Haimeri, E, et al. Analgesic effects of intra-articular morphine after arthroscopic knee surgery. N Engl J Med 1991; 325: 1123–6.CrossRefGoogle ScholarPubMed
Busch, CA, Shore, BJ, Bhandari, R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. J Bone Joint Surg 2006; 88: 959–63.CrossRefGoogle ScholarPubMed
Ogilvie, H. Large-intestine colic due to sympathetic deprivation. A new clinical syndrome. BMJ 1948; 2: 671–3.CrossRefGoogle ScholarPubMed
Rogers, M, Cerda, JJ.The narcotic bowel syndrome. J Clin Gastroenterol 1989; 11: 132–5.Google ScholarPubMed
Brill, S, McCartney, CJL, Weksler, N, Chan, VWS. Acute colonic pseudo-obstruction (Ogilvie's syndrome), lower limb arthroplasty and opioids. Acute Pain 2003; 5: 45–50.CrossRefGoogle Scholar
Weinger, MB. Dangers of postoperative opioids. APSF Newslett 2006–2007; 21(4):61–8.Google Scholar
Roy, S, Want, J Kelschenbach, Koodie, L, Martin, J. Modulation of immune function by morphine: implications for susceptibility to infection. J Neuroimmune Pharmacol 2006; 1: 77–89.CrossRefGoogle Scholar
Savage, S. Assessment for addiction in pain-treatment settings. Clin J Pain. 2002; 18(4):S28–38.CrossRefGoogle ScholarPubMed
Illgen, RL, Pellino, TA, Gordon, DB, Butts, S, Heiner, JP. Prospective analysis of a novel long-acting oral opioid analgesic regimen for pain control after total hip and knee arthroplasty. J Arthroplasty 2006; 21(6):814–20.CrossRefGoogle Scholar
Shirk, MB, Donahue, KR, Shirvani, J. Unlabeled uses of nebulized medications. Am J Health Syst Pharm 2006; 63(18):1704–16.CrossRefGoogle ScholarPubMed
Bamigbade, TA, Langford, RM. The clinical use of tramadol hydrochloride. Pain Rev 1998; 5: 155–82.CrossRefGoogle Scholar
Gardner, JS, Blough, D, Drinkard, CR, et al. Tramadol and seizures: a surveillance study in a managed car population. Pharmacotherapy 2000; 20(12):1423–31.CrossRefGoogle Scholar
Akinci, S, Saricaoglu, F, Atay, O, Doral, M, Kanbak, M. Analgesic effect of intra-articular tramadol compared with morphine after arthroscopic knee surgery. Arthroscopy 2005; 21(9): 1060–5.CrossRefGoogle ScholarPubMed
Langlois, G, Estebe, JP, Gentili, ME, et al. The addition of tramadol to lidocaine does not reduce tourniquet and postoperative pain during IV regional anesthesia. Can J Anaesth 2002; 49: 165–8.CrossRefGoogle Scholar
Altunkaya, H, Ozer, Y, Kargi, E, Babuccu, O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003; 90(3):320–2.CrossRefGoogle ScholarPubMed
Pang, WW, Mok, MS, Chang, DP, et al. Local anesthetic effects of tramadol, metaclopromide and lidocaine following intradermal injection. Reg Anesth Pain Med 1998; 23: 580–3.CrossRefGoogle ScholarPubMed
Turker, G, Goren, S, Bayram, S, Sahin, S, Korfali, G. Comparison of lumbar epidural tramadol and lumbar epidural morphine for pain relief after throracotomy: a repeated dose study. J Cardiothorac Vasc Anesth 2005; 19(4):468–74.CrossRefGoogle Scholar
Salman, MA, Sahin, A, Onur, MA, Öge, K, Kassab, A, Aypar, U. Tramadol encapsulated into polyhydroxybutyrate microspheres: in vitro release and epidural analgesic effects in rats. Acta Anaesth Scand 2003; 47(8):1006–12.CrossRefGoogle ScholarPubMed
Kissin, I, Bright, CA, Bradley, EL Jr. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations?Anesth Analg 2000; 91: 1483–8.CrossRefGoogle ScholarPubMed
Willman, EV.Andolfatto, G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007; 49(1):23–30.CrossRefGoogle ScholarPubMed
Koppert, W, Weigand, M, Neumann, F, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg 2004; 98: 1050–5.CrossRefGoogle ScholarPubMed
Conlay, L. Analgesic effects of intravenous lidocaine and morphine on post amputation pain: a randomized double blind, active placebo controlled, crossover trial. Surv Anesthesiol 2004; 48(1):43.CrossRefGoogle Scholar
Tanaka, T, Okano, S, Tsukui, R, et al. Continuous low dose intravenous lidocaine is effective for visceral pain secondary to peritoneal carcinomatosis in terminally cancer patients. ASCO Annual Meeting Proceedings Part 1. J Clin Oncol 2006; 24(18S): 8533.Google Scholar
Tremont-Lukats, IW, Challapalli, V, McNicol, ED, Lau, J, Carr, DB. Systemic administration of local anesthetics to relieve neuropathic pain: a systemic review and metanalysis. Anesth Analg 2005; 101: 1738–49.CrossRefGoogle Scholar
Finnerup, N, Biering-Sorensen, F, Johannesen, I, et al. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial. Anesthesiology 2005; 102(5):1023–30.CrossRefGoogle ScholarPubMed
Kaba, A, Laurent, SR, Detroz, BJ, et al. Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology 2007; 106: 11–8.CrossRefGoogle ScholarPubMed
Palmeri, TL, Greenhalgh, DG. Topical treatment of pediatric patients with burns: a practical guide. Am J Clin Derm 2002; 3(8):529–34.CrossRefGoogle Scholar
Zempsky, WT, Sullivan, J, Paulson, DM, Hoath, SB. Evaluation of a low dose lidocaine Iontophoresis system for topical anesthesia in adults and children: a randomized controlled trial. Clin Ther 2004; 26(7):1110–9.CrossRefGoogle ScholarPubMed
Mofenson, HC, Caraccio, TR, Miller, H, Greensher, J. Lidocaine toxicity from topical mucosal application. Clin Pediatr 1983; 22(3):190–2.CrossRefGoogle ScholarPubMed
Paneral, AE, Monza, G, Movilia, P, Francucci, BM, Tiengo, M. A randomized within-patient cross-over placebo-controlled trial on the efficacy and tolerability of the tricyclic antidepressants chlorimipramine and nortryptyline in central pain. Acta Neurol Scand 1990; 82: 34–8.CrossRefGoogle Scholar
Carter, GT, Sullivan, MD. Antidepressants in pain management. Curr Opin Investig Drugs 2002; 3(3):454–8.Google ScholarPubMed
Vieweg, WVR, Weed, MA. Tricyclic antidepressants, QT interval prolongation and Torsade de Pointes. Psychosomatics 2004; 45: 371–7.CrossRefGoogle ScholarPubMed
Ray, W, Meredith, S, Thapa, PB, Hall, K, Murray, KT. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharm Ther 2004; 75(3):234–41.CrossRefGoogle ScholarPubMed
Cappell, MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol 2004; 99(6):1175–90.CrossRefGoogle ScholarPubMed
Hayes JR, Bojral S, McCarthy MC. Gastrointestinal effects of tricyclic antidepressants: Ogilvie's syndrome. Psychosomatics 1987; 28: 442–3.CrossRef
Attal, N, Cruccu, G, Haanpaa, M et al. EFNS guidelines in pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13: 1153–69.CrossRefGoogle ScholarPubMed
Orii, R, Obashi, Y, Haldar, S, Giombini, M, Maze, M, Fujinaga, M. GABAergic interneurons at supraspinal and spinal levels differentially modulate the antinociceptive effects nitrous oxide in Fischer rats. Anesthesiology 2003; 98: 1223–30.CrossRefGoogle ScholarPubMed
Gottrup, H, Juhl, G, Kristensen, AD, et al. Chronic oral gabapentin reduces elements of central sensitization in human experimental hyperalgesia. Anesthesiology 2004; 101: 1400–8.CrossRefGoogle ScholarPubMed
Sihoe, AD, Lee, TW, Wan, IY, Thung, KH, Yim, AP. The use of gabapentin for post-operative and post-traumatic pain in thoracic surgery patients. Eur J Cardiothorac Surg. 2006; 29(5): 795–9.CrossRefGoogle ScholarPubMed
Coderre, TJ, Kumar, N, Lefebvre, CD, Yu, JS. Evidence that gabapentin reduces neuropathic pain by inhibiting the spinal release of glutamate. J Neurochem 2005; 94(4):1131–9.CrossRefGoogle ScholarPubMed
Seib, RK, Paul, JE. Preoperative gabapentin for postoperative analgesia: Meta-analysis. Can J Anesth 2006; 53: 461–9.CrossRefGoogle ScholarPubMed
Gilron, I, Bailey, JM, Dongsheng, Tu, Holden, RR, et al. Morphine, Gabapentin or their combination for neuropathic pain. N Engl J Med 2005; 352: 1324–34.CrossRefGoogle ScholarPubMed
Gilron, I. The role of anticonvulsant drugs in postoperative pain mangment: A bench to bedside perspective. Can J Anesth 2006; 53(6):562–71.CrossRefGoogle Scholar
Dahl, JB, Mathiesen, O, Moiniche, S. ‘Protective premedication’: An option with gabapentin and related drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain. Acta Anaesth Scand 2004; 48: 1130–6.CrossRefGoogle ScholarPubMed
Pandey, A, Feltner, D, Jefferson, J, et al. Efficacy of the novel anxiolytic pragabalin in social anxiety disorders: a placebo-controlled, multicenter study. J Clin Psychopharmacol 2004; 24(2):141–9.CrossRefGoogle Scholar
Beghi, E. Efficacy and tolerability of the new antiepileptic drugs: comparison of two recent guidelines. Lancet Neurol 2004; 3: 618–21.CrossRefGoogle ScholarPubMed
MacPherson, RD. The pharmacological basis of contemporary pain management. Pharmcol Therapeut 2000; 88: 163–85.CrossRefGoogle ScholarPubMed
Talon, MD, Woodson, LC, Sherwood, E, Aarsland, A, McRae, L. Nasal Dexmedetomdine is comparable to Midazolam as preoperative sedative in children. Anesthesiology 2007; 107: A1398.Google Scholar
Khan, ZP, Ferguson, CN, Jones, RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia 1999; 54: 146–65.CrossRefGoogle ScholarPubMed
Vulliemoz, Y, Virag, L, Whittington, RA. Interaction of alpha-2-adrenergic and opioid receptor with the cGMP system in the mouse cerebellum. Brain Res 1998; 813: 26–31.CrossRefGoogle ScholarPubMed
Xu, Z, Li, P, Tong, C, Figuero, J, Tobin, JR, Eisenach, JC. Location and characteristics of nitric oxide synthetase in sheep spinal cord and its interaction with alpha(2)-adrenergic and cholinergic anti-nociception. Anesthesiology 1996; 84: 890–9.CrossRefGoogle Scholar
Bernard, JM, Hommeril, JL, Passuti, N, Pinaud, M. Postoperative analgesia by intravenous clonidine. Anesthesiology 1991; 75: 577–82.CrossRefGoogle ScholarPubMed
Daqing, M, Rajakumaraswamy, N, Maze, M. (2-Adrenoceptor agonists: shedding light on neuroprotection?Br Med Bull 2005; 71(1):77–92.Google Scholar
Virtanen, R, Savola, JM, Sano, V, Nyman, L. Characterization of selectivity, specificity and potencvy of medetomidine as alpha-2 adrenoreceptor agonist. Eur J Pharmacol 1988; 150: 9–14.CrossRefGoogle Scholar
Arain, SR, Ruehlow, RM, Uhrich, TD, Ebert, TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98: 153–8.CrossRefGoogle ScholarPubMed
Lyons, FM, Bew, S, Sheeran, P, Hall, GM. Effects of clonidine on pituitary hormonal response to pelvic surgery. Br J Anaesth 1997; 78: 134–7.CrossRefGoogle ScholarPubMed
Mukhtar, AM, Obayah, EM, Hassona, AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg 2006; 103: 52–6.CrossRefGoogle ScholarPubMed
Patterson, DR, Ptacek, JT, Carrougher, GJ, Sharar, SR. Loreqepam as an adjunct to opioid analgesics in the treatment of burn pain. Pain 1997; 72(3):367–74.CrossRefGoogle ScholarPubMed
Kaabachi, O, Ouezini, R, Koubaa, W, Ghrab, B. Comparative study between mask nebulization and oral administration of midazolam in children. Anesthesiology 2007; 107: A1095.Google Scholar
Scott, R. Buccal midazolam as rescue therapy for acute seizures. Lancet Neuro 2005; 4(10):592–3.CrossRefGoogle ScholarPubMed
Harbord, MG, Kyrkou, NE, Kay, D, Coulthard, KP. Use of intranasal midazolam to treat acute seizures in paediatric community settings. J Paediatr Child Health 2004; 40(9–10):556–8.CrossRefGoogle ScholarPubMed
Whiting, PJ. GABA-A receptor subtype in the brain: A paradigm for CNS drug delivery. Drug Discov Today 2003; 8: 445–50.CrossRefGoogle Scholar
Yaksh, TL, Allen, JW. The use of intrathecal Midazolam in humans: a case study process. Anesth Analg 2004; 98: 1536–45.CrossRefGoogle Scholar
Goh, PL, Lee, SW, Goh, SH. Analgesia for adult distal radius fracture manipulation in the emergency department: demand valve nitrous oxide compared with intravenous regional anaesthesia. Hong Kong J Emerg Med 2002; 9(4):181–7.CrossRefGoogle Scholar
Wilson, MJ, Hunter, JB. Supracondylar fractures of the humerus in children-wire removal in the outpatient setting. Injury Extra 2006; 37(8):313–5.CrossRefGoogle Scholar
Burm, AGL. Occupational hazards of inhalational anaesthetics. Best Pract Res Clin Anaesthesiol 2003; 17: 147–61.CrossRefGoogle ScholarPubMed
Ziegler, AW, Agarwal, NN. Morbidity and mortality of rib fractures. J Trauma 1994; 37: 975–9.CrossRefGoogle ScholarPubMed
Bergeron, E, Lavoie, A, Clas, D, et al. Elderly trauma patients with rib fractures are at a greater risk of death and pneumonia. J Trauma 2002; 54: 478–85.CrossRefGoogle Scholar
Schneider, JC, Harris, NL, Shami, El A, et al. A descriptive review of neuropathic-like pain after burn injury. J Burn Care Res 2006; 27(4):524–8.CrossRefGoogle ScholarPubMed
Jellish, WS, Gamelli, RL, Furry, PA, McGill, VL, Fluder, EM.Effect of topical local anesthetic application to skin harvest sites for pain management in burn patients undergoing skin-grafting procedures. Ann Surg 1999; 229(1):115–20.CrossRefGoogle ScholarPubMed
Wehner, D, Hamilton, GC.Seizures following application of local anesthetics to burn patients. Ann Emerg Med 1984; 13: 456–8.CrossRefGoogle ScholarPubMed
Rincon, E, Bakern, RL, Iglesias, AJ, Duarte, AM. CNS toxicity after topical application of EMLA cream with molluscum contagiosum. Pediatr Emerg 2000; 16: 252–4.CrossRefGoogle ScholarPubMed
Hahn, IH, Hoffman, RS, Nelson, LS. EMLA induced methemogobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26(1):85–8.CrossRefGoogle ScholarPubMed
Heinrich, M, Wetzstein, V, Muensterer, OJ, Till, H. Conscious sedation: Off label use of rectal S(+) ketamine and midazolam for wound dressing changes in paediatric heat injuries. Eur J Pediatr Surg 2004; 14(4):235–9.CrossRefGoogle ScholarPubMed
Summer, G, Puntillo, K, Miaskowski, C, Green, P, Levine, J. Burn injury pain. The continuing challenge. J Pain 2007; 8(7):533–48.CrossRefGoogle ScholarPubMed
Baker, RA, Zeller, RA, Klein, RL, et al. Burn wound itch control using H1 and H2 antagonists. J Burn Care Rehabil 2001; 22(4): 263–8.CrossRefGoogle ScholarPubMed
Mendham, JE. Gabapentin for the treatment of itching produced by burns and wound healing in children: a pilot study. Burns 2004; 30(8):851–3.CrossRefGoogle ScholarPubMed
Jacob, E, Puntillo, KA.Variabiltiy of analgesic practices for hospitalized children on different pediatric speciality units. J Pain Symptom Manage 2000; 20: 59–67.CrossRefGoogle Scholar
Cohen, SP, Christo, PJ, Moroz, L.Pain management in trauma patients. Am J Phys Med Rehabil 2004; 83: 142–61.CrossRefGoogle ScholarPubMed
Clark, E, Plint, AC, Correll, R, Gaboury, I, Passi, B. A randomized controlled trial of acetaminophen, ibuprofen and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics 2007; 119(3):460–7.CrossRefGoogle ScholarPubMed
Falanga, IJ, Lafrenaye, S, Mayer, SK, Tetrault, JP.Management of acute pain in children: Safety and efficacy of a nurse-controlled algorithm for pain relief. Acute Pain 2006; 8: 45–54.CrossRefGoogle Scholar
Patterson, DR, Hoffman, HG, Weichman, SA, Jensen, MP, Sharar, SR. Optimizing control of pain from severe burns: a literature review. Am J Clin Hypn 2004; 47(1):43–54.CrossRefGoogle ScholarPubMed
Lang, T, Barker, R, Steinlechner, B, et al. TENS relieves acute posttraumatic hip pain during emergency transport. J Trauma 2007; 62: 184–8.CrossRefGoogle ScholarPubMed
McMakin, CR, Gregory, WM, Phillips, TM. Cytokine changes with microcurrent treatment of fibromyalgias associated with cervical spine trauma. J Bodywork Move Ther 2005; 9: 169–76.CrossRefGoogle Scholar
Ducharme, J.Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document. J Emerg Med 1994; 12: 855–66.CrossRefGoogle ScholarPubMed

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  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.037
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  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.037
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pharmacologic Management of Acute Pain in Trauma
    • By Shalini Dhir, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Veerabadran Velayutham, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada, Sugantha Ganapathy, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.037
Available formats
×