Although one would expect side-effects to be more common in elderly patients some studies have shown analgesics can be used, as frequently in this group of patients, without problems. 8 and we know of no evidence that adequate analgesia in the mentally alert patient masks significant occult injury. Failure to perceive the degree of pain associated with acute musculoskeletal trauma 1,9 is the main reason for patients not receiving adequate analgesia. This can be addressed with improved information and education for both medical and nursing staff who may be making value judgements regarding the need for analgesics. 10,11 and this role could be extended to include preoperative analgesia.
Intravenous opiates are the most effective analgesia in acute trauma.
Epidural infusions have a role to play in major lower limb trauma. It is important to address our prescribing and administration of analgesia well as the use of adjuvant treatment measures so patients receive the analgesia that they require in the preoperative period. Education of medical and nursing staff and review of analgesic prescribing policies may help to improve the current situation. Use of analgesia in severe pain in the accident and emergency department. Oligoanalgesia in the Emergency Department.