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.