Regional anesthesia for the trauma patient: improving patient outcomes

Abstract

Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.

Ablación térmica de nervios intercostales por radiofrecuencia para dolor por fracturas costales múltiples

“…Los resultados observados en nuestro estudio están en concordancia con la literatura mundial al observar una reducción importante del consumo de morfina diaria. 15,19 Cirujano General 2020; 42 (1): 24-30 www.medigraphic.com/cirujanogeneral www.medigraphic.org.mx…”

“…[7][8][9][10] Este daño permanente del nervio intercostal permite una importante analgesia, puede realizarse con el paciente en decúbito dorsal sin necesidad de cambios de posición e inclusive dentro de las unidades de terapia intensiva si www.medigraphic.org.mx se utiliza como guía el ultrasonido, además la analgesia es permanente, lo que permite al paciente una buena mecánica respiratoria, previene atelectasias pulmonares o neumonía y disminuye el uso de analgésicos. [11][12][13][14][15] Con base en lo anterior se comenzó a realizar radiofrecuencia de los nervios intercostales en nuestro hospital para el tratamiento del dolor y mejorar la mecánica respiratoria en los pacientes con trauma contuso de tórax. Este trabajo surge de la necesidad de poder controlar el dolor severo que presentan los pacientes y cómo mejorar su mecánica respiratoria para una extubación temprana; y se ha perfilado como una opción al tratamiento médico y quirúrgico tradicional del paciente en nuestro hospital.…”

Pediatric Anesthesia Concerns and Management for Orthopedic Procedures

“…Strategies to minimize complications include identifying high-risk patients, such as those undergoing tibial compartment surgery; using dilute solutions of local anesthetics and cautious use of additives to decrease the density of the block; appropriate monitoring of symptoms; and measurement of compartment pressure if compartment syndrome is suspected. 37,38…”

Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial

“…Pain related to trauma surgery is frequently severe, but remains undertreated [1,2]. Opioids and non-steroidal antiinflammatory drugs have been recently questioned due to undesirable adverse effects in a multi-trauma patient having neurologic and respiratory impairment [2,3]. In con-trast, regional analgesia confers site-specific pain relief and prevents sensitization for the development of chronic pain [3].…”