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Abstract
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Background and Aims Effective pain management is crucial during the process of ventilator weaning for patients in intensive care units, as pain experienced during this process can increase respiratory effort. We present a clinical case that highlights the importance of pain control through the use of regional analgesic techniques for early ventilatory weaning.
Methods We present a clinical case involving a 61-year-old woman admitted due to polytrauma following a fall from a second-floor building. This resulted in several primary injuries, including an open fracture of the left tibial pilon, multiple comminuted fractures of the left foot, a fracture of the diaphysis of the right femur and of the lumbar vertebrae L1-L5, necessitating urgent surgical intervention. Following surgery, the patient was transferred to the ICU, where remained sedated and ventilated for four days until sedoanalgesia and ventilatory weaning were initiated. However, the process was hindered by poorly controlled pain perception, with the trauma of the left lower limb being the primary pain trigger. A multimodal analgesic strategy was implemented, incorporating systemic analgesia (Paracetamol, Ketorolac, Gabapentin, and Amitriptyline) and the placement of continuous femoral and sciatic perineural catheters (PNC) on the left side, guided by ultrasound. Twenty-four hours after the placement of both PNC, adequate pain control was achieved, facilitating a successful attempt at ventilatory weaning. The PNCs remained functional for 12 days, after which they were removed, with no complications registered.
Conclusions Appropriate pain management is essential for ventilator weaning success, with regional analgesia techniques serving as safe and effective options to enhance this outcome.
Main painful trigger after surgical stabilization
Femoral and sciatic perineural catheters (popliteal route)