Pain Management in a Case of Severe Electrocution Injury and Resultant Quadruple Amputation

IF 0.2 Q4 EMERGENCY MEDICINE
Shigong Guo, M. Moiz, D. H. Slater
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引用次数: 0

Abstract

Background: A 33-year-old patient presented to the Oxford Centre for Enablement for rehabilitation following severe electrical burn injuries requiring bilateral below elbow amputations, right below knee amputation and a left midfoot amputation. Specific issues: Chronic pain at the amputation sites as well as phantom limb initially proved challenging to manage medically however were eventually controlled with careful consideration of analgesic regimens. Pain was measured using the Numeric Pain Rating Scale. A likely attributing cause for the pain was peripheral neuropathy. Management: A combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used. Implications: Rigorous search strategies were created which interrogated the MEDLINE, EMBASE, CINAHL, PsycINFO databases for studies reporting limb pain management in electrocution injuries. A total of 841 studies were found with 583 screened after removal of duplicates. No RCTs could be identified investigating limb pain management in electrical injuries. Case reports and case series have described various treatment options including nerve blocks, neuropathic analgesia, physiotherapy, botulinum toxin, fracture fixation and even the use of Virtual Reality headsets.  We discuss this available evidence. No consensus exists as to the optimum management approach of pain in such patients. From our experience with this patient we suggest that a multi- modal analgesic approach is likely to be needed in such patients and should therefore be considered. Level 1 research into pain management in electrocution injuries is required.
1例严重触电伤致四肢截肢的疼痛处理
背景:一名33岁的患者在严重电烧伤后,需要双侧肘部以下截肢,右膝以下截肢和左足中部截肢,随后来到牛津康复中心接受康复治疗。具体问题:截肢部位的慢性疼痛以及幻肢最初证明具有挑战性,但最终通过仔细考虑镇痛方案得到控制。疼痛采用数字疼痛评定量表进行测量。疼痛的可能原因是周围神经病变。治疗方法:神经病变药物和阿片类药物联合使用有助于控制疼痛。这些镇痛药包括阿米替林、加巴喷丁、普瑞巴林、曲马多和吗啡。还使用了扑热息痛和布洛芬。意义:建立了严格的搜索策略,查询MEDLINE, EMBASE, CINAHL, PsycINFO数据库,以报告触电损伤中肢体疼痛管理的研究。共发现841项研究,剔除重复项后筛选出583项。未发现调查电损伤肢体疼痛管理的随机对照试验。病例报告和病例系列描述了各种治疗方案,包括神经阻滞、神经性镇痛、物理治疗、肉毒杆菌毒素、骨折固定,甚至使用虚拟现实耳机。我们讨论这些现有的证据。对于此类患者疼痛的最佳治疗方法尚无共识。根据我们对这名患者的经验,我们建议在这类患者中可能需要多模式镇痛方法,因此应予以考虑。一级研究的疼痛管理在触电伤害是必需的。
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来源期刊
Trauma monthly
Trauma monthly EMERGENCY MEDICINE-
CiteScore
0.60
自引率
0.00%
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0
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