Critical Care Medicine-Neurologic Disorders>>>>>Analgesia, Sedation and Neuromuscular Blockade
Question 1#

A 76-year-old female is admitted after falling on her stairs and fracturing multiple ribs. She is transferred to the intensive care unit (ICU) for increased oxygen requirement. She reports that her pain is very severe. Her breathing is rapid and shallow.

Which of the following would be the MOST effective method of controlling her pain?

a. Intravenous narcotic patient controlled analgesia
b. Lidocaine patch over fracture area
c. Epidural catheter with infusion of local anesthetic
d. Acetaminophen
e. Lorazepam

Correct Answer is C

Comment:

Correct Answer: C

Although epidural anesthesia has not definitively been shown to decrease mortality, pulmonary complications, or length of stay in patients with rib fractures, it has been shown to provide superior subjective pain control compared to intravenous narcotics. Lorazepam has no analgesic properties. Lidocaine patches and acetaminophen are good analgesia adjunctive therapies but would not be adequate to control this patient’s pain when used as a primary agent.

Reference:

  1. Galvagno SM, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81(5):936-951.