This assignment will critically analyse the current aspects of acute pain control in defence healthcare. The focus of this discussion will examine current methods of pain management utilised in British military trauma patients for repatriation via Aeromedical Evacuation (AE). This will include the use of Continuous Peripheral Nerve Block’s (CPNB), Patient Controlled Analgesia (PCA) and epidurals. In order to maintain confidentiality, all names will be replaced with pseudonyms in accordance with the Nursing and Midwifery Council (NMC 2008).
According to the British Pain Society (2008), acute pain can last up to two weeks. This is supported by Ready and Edwards (1992) who state that acute pain is of limited duration. Pain has been defined as a sensory and emotional response to tissue damage (Mersky and Bogduk 1994) The International Association for the Study of Pain (IASP 2011) supports this definition by stating that it is an unpleasant experience associated with tissue damage, however McCaffrey and Beebe (1989) suggest that pain is more than tissue damage as it is also based on the patients experience. The IASP (2011) does not support McCaffrey’s definition as they recognise that a patient’s inability to verbally communicate their experience, does not negate the possibility that they are in pain.
Acute pain related to injury, resolves with treatment, such as analgesia (Durate 1997). According to the World Health Organisation (WHO, 2007), effective analgesia is imperative in post operative pain management. Under The Human Rights Act (1998) patients have a right to pain relief and as healthcare professionals, we have an
obligation to ensure our patients are free from pain (NMC 2008). We are duty bound as healthcare professionals, to treat pain (Brennan et al, 2007) and a failure to do so would result in maleficence our patients would be subjected to unnecessary harm (Beauchamp and Childress 2009).
Military trauma patients often have multiple injuries mainly due to blasts from improvised explosive devices (IED‘s) or gunshot wounds, and commonly involving the limb (Clark et al 2007). This is echoed by Mercer et al (2010) who outline trauma pathways for ballistic, blunt and blast trauma, all of which potentially involve the limbs. These multiple injuries sustained by British military personnel provide significant levels of pain (Braganza 2002) and therefore innovative pain management techniques need to be utilised (Clark et al 2007). The IASP (2011) agree that due to the advances in battlefield medicine and protective equipment, soldiers are now surviving more traumatic injuries. They identify that this has caused an issue with managing acute pain, and so developments in approaches to acute pain for combat related injuries has been needed.
Despite pain being highlighted as a significant issue for military trauma and a key area of focus for the Surgeon General (Connor et al 2009), a systematic approach to pain management is not included in trauma algorithms, the focus remains on resuscitation, massive blood transfusion and damage control surgery (Clark et al 2007). Pain management is identified and usually initiated concurrently with resuscitation, however, treatment is standardised and not dealt with systematically. The pain management of
trauma patients is initiated on the ground, traditionally IM morphine, then continued during evacuation by the Medical Emergency Response Team (MERT) to the Role 3 (IASP 2011). Pain management is difficult in the air with MERT, due to the environment. Lack of access to the patient, short journey time before arrival at the Role 3, and lack of communication regarding treatment already given can sometimes be an issue (Clasper and Aldington 2010). However, advances in military medicine and the recognition that pain management is essential from point of wounding (Connor et al 2009) have seen pain relief...
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