Pain therapy in orthopedic and trauma surgery
The therapeutic area of orthopedics and traumatology takes care of the full spectrum of cases ranging from patients with a single fracture to those suffering from multiple, life-threatening musculoskeletal injuries. The spectrum of treatments is large, including for example hip and knee replacement for both traumatic injuries and degenerative arthrosis, surgical approaches to herniated disks, scoliosis and all kinds of bone fractures.
In order to effectively manage pain while reducing the opioid consumption including their associated side effects, multimodal pain management strategies have become an important part during the peri-operative care process of patients undergoing orthopedic and trauma surgery.
The resulting patient individual selection of the best suited anesthesia and/or analgesia method depends on the patient’s specific diagnosis, status, preference and targeted treatment approach. In traumatic situations, a combination of general anesthesia methods, enabling the operating physicians to instantly react to unexpected conditions and further arising complications, might be indicated together with (continuous) post-surgical pain treatment techniques. Elective operations, especially at upper and lower extremities, are most likely suited for regional anesthesia techniques such as neuraxial methods and/or peripheral nerve blocks for knee replacement.
Local Anesthetics (LA) prevent or relieve pain by interrupting nerve conduction. LAs can be divided into three categories: short acting (45-90 minutes), intermediate duration (90-180 minutes), and long acting (4-18 hours) and are mainly used for regional anesthesia techniques. The role of and demand for regional anesthesia will continue to grow as it has became evident that these techniques considerably improve patient outcome.
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The anesthetic method chosen decides upon the options for patient access, e.g. peripheral venous lines appropriate for general anesthesia, neuraxial access devices required for spinal and epidural anesthesia, or peripheral nerve block devices for plexus anesthesia. The access to peripheral nerves is possible via single-shot needles or catheter systems, providing continuous post-operative pain management for multiple days.
In addition to the access paths described above, a peripheral venous access is indicated to manage supplementary infusion therapy, and to have an access option in place in case unforeseen emergencies might occur.
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Epidural is frequently used and represents the administration of a local anesthetic solution into the so-called epidural space.
Combined Spinal Epidural
The Combined Spinal Epidural (CSE) Technique can reduce or eliminate some of the disadvantages of spinal and epidural anaesthesia while preserving their advantages.
Peripheral Nerve Block
Blockade of the peripheral nerves with local anaesthetics can provide superior anaesthesia of the upper and lower extremities.
The preparation depends on the anesthesia and/or analgesia method chosen. In general, medication, the respective medical devices and equipment (e.g. ultrasound machine and nerve stimulator) required for the procedure have to be selected. Specific procedure kits, containing all products required to perform the anesthetic procedure, are viable options for a safer and more efficient organization of this procedure.
In case there is “no ready to use drug container option” available, individual drawing-up activities into the appropriate application containers, such as syringes and elastomeric pumps, will follow the described preparation steps.
Correct patient positioning, a prerequisite for a successful placement of neuraxial and peripheral nerve block needles and catheters, completes the procedural preparation.
For the most effective application of anesthetic and analgesic drugs it is crucial to find the correct point and route into the patient’s body.
- Flashback-technologies for peripheral venous catheters and spinal needles
- Ultrasound-guided and ECG-controlled placement of central venous catheters
- Loss-of-resistance method in epidural anesthesia
- Triple monitoring techniques via ultrasound, nerve stimulation and injection pressure in peripheral nerve blocks
- TIVA and TCI algorithms included in smart syringe pumps offer effective solutions, helping preventing errors in conducting the various analgesia and anesthesia options.
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For an early postoperative mobilization which decisively impacts patient’s outcome and discharge from the hospital, there are effective ways to continue the post-operative management of pain. When applying continuous peripheral nerve block or wound infusion catheters, portable, single use elastomeric pumps, administer the necessary anesthetics to the patient, even in the home care setting.