Regional anesthesia for trauma patients

Trauma patients demands special medical care. Pain is frequently under-treated in the early phase of trauma. Pain is a major symptom of surgical conditions and minimizing pain could lead to misdiagnoses and technical facilities are not appropriate for adequate pain treatment. Consequences of inappropriate pain treatment could aggravate stress response, increases oxygen demand and led to myocardial ischemia Analgesia with parenteral opioids is effective but carries a risk of respiratory depression, nausea and hypotension. Regional anesthesia (RA) is well established method for analgesia in surgical patients for intraoperative and postoperative pain relief Neuroaxial and peripheral nerve blocks are effective procedures for acute pain treatment. Nerve stimulation and advances in ultrasound guide nerve blocks make those procedures safer and even more desirable. Advantages of RA over systemic analgesia in trauma patients are numerous. Application of local anesthetics produce excellent pain control with decreased stress response and minimal systemic effects is applied properly. Main indications for RA include patients with rib fractures and lower and upper extremities injuries. Anesthesiologist performing RA must be aware of pathophysiology changes in trauma patients especially addressing compartment syndrome and coagulation abnormalities. Best way is to weighed risk against the benefit of RA in trauma patients individually with increased vigilance and monitoring for eventual side effects.