Acute Trauma Pain Control Algorithm.

T is a major cause of mortality throughout the world but in recent years, major advances have been made in the management of trauma which has been reduced mortality [1]. Pain management and control is a critical part of trauma care. In the recent 3 decades, there has been a growing interest in pain management of trauma patients following some studies which showed that these patients are generally under medicated leading to less desirable outcomes of hospitalization [2,3]. Study of Alpen et al., [4] showed that uses of nonopioid drugs should be considered in all trauma patients and is good for patients sustaining trauma and being discharged within 24 hours. In a study showed that uses of opioids analgesia like morphin will improve pain relief for postoperative pain management and is effective and has efficacy before anesthesia [5,6]. Since the major complaint in the patients with multiple rib fracture or long bone fracture is having severe pain while breathing or coughing or even during body movements, rapid control of the pain results in decreased systemic complications and complications of pulmonary system related to pain such as decreased ventilatory effort leading to hypoxia or development of atelectasis and pneumonia. Currently there is a great controversy in providing a clear protocol for managing pain in trauma patients. In this regards we would like to share our experience of pain control in trauma patients with rib fracture or long bone fractures in a level I trauma center in southern Iran (Shiraz). We encountered several problems with patient’s satisfaction and undesirable outcome of hospitalization mostly due to improper pain control in emergency department (ER), although primary and secondary surveys were performed properly. Until recently, over a period of time based on a review of the literature and experiences of our experts in the center, clear protocols with detailed pathways were designed in order to meet the needs. The protocol (Figure 1) being used in our center for pain control of the adult trauma patients with rib fracture or long rib fractures and GCS>13 consists of three lines of therapy. In the first and second lines, acetaminophen and opiate agents are our preferences because these agents are easily administered with no need for highly experienced staff. Due to limitations of surgical interventions like higher costs or the invasive nature of these procedures, inability to perform for *Corresponding author: Fariborz Ghaffarpasand Address: Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Chamran Avenue, PO Box: 71345-1876, Shiraz, Iran. Tel: +98-917-3095214, Fax: +98-71-32330724 e-mail: [email protected] Received: July 22, 2014 Accepted: August 10, 2014