14 - The Management of Acute and Perioperative Pain Associated With Trauma and Surgery

Abstract

The management of pain after trauma and surgery has advanced tremendously over the past decade. The opioid “crisis” has helped to speed this along, and in this chapter the authors give an in-depth overview of the state of the art of Acute Pain Medicine. Topics that vary from the physiology of acute pain, its assessment, to its treatment are discussed in much detail. Nerve blocks that include single-injection, continuous and neuraxial blocks are discussed and especially a number of very recent anatomical “discoveries” over the past 5 years changed our approach to nerve blocks and especially continuous nerve blocks. They are discussed in detail, and videos of common nerve blocks and their applied anatomy are presented, which includes ambulatory continuous peripheral nerve blocks that seem to be again gaining in popularity as the basic microanatomy is better understood following these “new” anatomical discoveries applied to old physics and anatomical “laws” such as Hilton’s Law of Anatomy and Fick’s Law of Diffusion. Finally a spotlight is shone on controversial issues such as the use of regional anesthesia in patients at high risk of acute compartment syndrome as well as the use of liposomal bupivacaine—only the facts. This chapter concludes with a discussion of the collaboration between orthopaedic surgeons and acute pain medicine specialists.