Pain management in thoracic trauma

Efficacy of perioperative multimodal analgesia in minimally invasive thoracoscopic treatment for severe blunt chest trauma with hemopneumothorax

This retrospective study evaluates the clinical impact of perioperative multimodal analgesia in the minimally invasive treatment of severe blunt chest trauma with hemopneumothorax using a thoracoscopic Ni-Ti shape memory embracing plate. A total of 100 patients with severe blunt chest trauma and moderate to severe hemopneumothorax treated at Hanyang Hospital affiliated with Wuhan University of Science and Technology from January 2019 to January 2022 were enrolled. Patients were divided into 2 groups: a control group (50 patients) receiving patient-controlled intravenous analgesia (PCIA), and a study group (50 patients) administered a multimodal analgesia regimen. Pain severity scores, vital signs, and inflammatory markers were compared between the groups. Post-surgery, both groups exhibited reductions in resting and movement-associated pain scores compared to admission values, with the study group showing significantly greater reductions (P < .05). Specifically, the average heart rate in the study group was 78 ± 8 beats per minute compared to 85 ± 9 beats per minute in the control group at 3 days postsurgery (P < .05). The respiratory rate was also lower in the study group (18 ± 2 breaths per minute) compared to the control group (21 ± 3 breaths per minute; P < .05). Improvements in blood oxygen saturation were observed postoperatively in both groups, with more pronounced changes in the study group (P < .05). Although levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein increased postoperatively in both groups, these increases were significantly lower in the study group (P < .05). Perioperative multimodal analgesia in patients with severe blunt chest trauma and pneumothorax enhances postoperative recovery, reduces pain, minimizes lung complications, and lowers the usage of analgesic drugs and their associated adverse effects.

Effect of Injury Patterns on the Development of Complications and Trauma-Induced Mortality in Patients Suffering Multiple Trauma

Patients that suffer from severe multiple trauma are highly vulnerable to the development of complications that influence their outcomes. Therefore, this study aimed to evaluate the risk factors that can facilitate an early recognition of adult patients at risk. The inclusion criteria were as follows: admission to a level 1 trauma center, injury severity score (ISS) ≥ 16 (severe injury was defined by an abbreviated injury score (AIS) ≥ 3) and ≥18 years of age. Injury- and patient-associated factors were correlated with the development of four complication clusters (surgery-related, infection, thromboembolic events and organ failure) and three mortality time points (immediate (6 h after admission), early (>6 h-72 h) and late (>72 h) mortality). Statistical analysis was performed using a Chi-square, Mann-Whitney U test, Cox hazard regression analysis and binominal logistic regression analysis. In total, 383 patients with a median ISS of 24 (interquartile range (IQR) 17-27) were included. The overall mortality rate (27.4%) peaked in the early mortality group. Lactate on admission significantly correlated with immediate and early mortality. Late mortality was significantly influenced by severe head injuries in patients with a moderate ISS (ISS 16-24). In patients with a high ISS (≥25), late mortality was influenced by a higher ISS, older age and higher rates of organ failure. Complications were observed in 47.5% of all patients, with infections being seen most often. The development of complications was significantly influenced by severe extremity injuries, the duration of mechanical ventilation and length of ICU stay. Infection remains the predominant posttraumatic complication. While immediate and early mortality is mainly influenced by the severity of the initial trauma, the rates of severe head injuries influence late mortality in moderate trauma severity, while organ failure remains a relevant factor in patients with a high injury severity.

An Unexpected 12.6 Centimeter Nail in the Thorax Damaging Vital Structures: A Case Report “Nailed It”

We report a patient who was referred to the emergency room with pulmonary complaints and where a computed tomography (CT) scan showed an unexpected 12.6 cm nail in the thorax penetrating part of the left pulmonary upper lobe, the left pulmonary artery, the left main bronchus, and the descending aorta, which had been in situ for at least three days. The quickly deteriorating patient had to be transferred to a tertiary academic hospital where the nail was successfully surgically removed. The comprehensive description of this unique case with a discussion of the critical decision moments could render insights into the management of challenging trauma cases.