Anelgesia Fisio


Pain Management in Trauma Patients
Trauma is the most frequent cause of death around the world, so pain management can be improving comfort in trauma patients and long term outcomes, because of the chronic pain that suffering this can be involving there are some methods that medical staff can use as analgesia in this patients and pain control in these conditions
Though pain management increasethe comfort of patient there are some reasons for its unimportance like a unfounded fear of addiction, an exaggerated concern about hemodynamic instability and respiratory depression.
Son this kind of poor management can improve into different problems that include anatomic and physiological. For example all is into nervous system with a property called neuroplasticity can lead to chronic pain ordisabling pain in consequence of a poor treatment.
Also people can suffer a response because of the stress that includes elevated levels of catecholamines, cortisol, growth hormone, and adrenocorticotropic hormone; activation of the renninangiotensin system; impaired coagulability.
Furthermore there are some adverse effects such a problem in gastrointestinal and renal function, although it isimportant to maintain care of this patients for increasing relief.
Analgesic Agents.
There are two different analgesic agents which are used in trauma and can have effects in inhibition of cyclo-oxygenase(COX) but their difference is in the intensity of pain that they are used.
Acetaminophen.
It is known as a metabolic predecessor that acts in the metabolism of prostaglandin, it can cross the bloodbrain barrier and produce analgesia. This also is not used in several pain but has a better use as an adjunct medication in advanced traumas with a maximum dose of 65 mg/kg/day. It acts in antipyresis and can easily drop by renal system.
NSAIDS (nonsteroidal Anti-inflammatory drugs).
It is used in low dose and can inhibit platelet function and synthesis of prostaglandin, NSAIDS is used mainly inpowerful pain as a fist line treatment.
Opioid.
This is the top of analgesic agents when a patient suffer pain because of trauma, it acts mainly in CNS around brainstern, thalamus, forebrain and spinal cord. It hyperpolarize the membrane by the activation Potassium channels and reducing Calcium channels. So in consequence it focuses the activation of neurotransmitters and inhibiting adenylatecycle.

Adjuvants
Ketamine
It is used as type of general anesthesia, so it can act as an agonist of sigma receptors of opioids and an antagonist of muscarinic receptors, it can act better in cardiovascular system that opioids nevertheless it causes generally hallucination and other kind of secondary effects.
Local anesthetics
Some as lidocaine are used better in patients that suffered trauma by a burnalthough it is better to used it in small dose because of the consequences in nervous system. It cans relief pain about 4-6 hours when the application is in a topical way.
Antidepressants.
TCA (tricycle antidepressants) acts in neurotransmitters by the inhibition of serotonin and norepinephrine so as a consequence it cans an effect in pain bye analgesic and antidepressant so according to studiesTCA provides a less depend of opioids when people suffer trauma.
Clonidine
It is not good to aplicate this kind of anesthetic in people who is hemodynamic unstable because of the risk of hypotension but it can be used with a sedative property. It can be implicated in oral, intravenous, transdermal and neuraxial way.
Corticosteroids.
Used basically in people who have been in soft tissue damage,increase intracranial pressure; it includes prednisone, hydrocortisone, and methylprednisolone.

Pain Relieve Procedures.

Pharmacologic Interventions.
The first way of interventions is by epidural anesthesia it is mainly applied in neuraxially or periphery way, so it can block sodium channels and by this way block some fibers of nerves. A, C receptor responsible of pain are not just the ones which...