1
|
Soulioti E, Pertsikapa M, Fyntanidou B, Limnaios P, Sidiropoulou T. Trauma Patients and Acute Compartment Syndrome: Is There an Ariadne's Thread That Can Safely Guide the Anesthesiologist/Emergency Physician Out of the Labyrinth? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1279. [PMID: 39202560 PMCID: PMC11356385 DOI: 10.3390/medicina60081279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 07/20/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
Trauma patients in the emergency department experience severe pain that is not always easy to manage. The risk of acute compartment syndrome further complicates the analgesic approach. The purpose of this review is to discuss relevant bibliography and highlight current guidelines and recommendations for the safe practice of peripheral nerve blocks in this special group of patients. According to the recent bibliography, peripheral nerve blocks are not contraindicated in patients at risk of acute compartment syndrome, as long as there is surveillance and certain recommendations are followed.
Collapse
Affiliation(s)
- Eleftheria Soulioti
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| | - Marianthi Pertsikapa
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.P.); (B.F.)
| | - Barbara Fyntanidou
- Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.P.); (B.F.)
| | - Pantelis Limnaios
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| | - Tatiana Sidiropoulou
- Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.S.); (P.L.)
| |
Collapse
|
2
|
Huaguo Y, Kang S, Hu L, Zhou H. Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers. Eur J Trauma Emerg Surg 2024; 50:1381-1390. [PMID: 38649528 DOI: 10.1007/s00068-024-02523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Trauma, particularly extremity trauma, poses a considerable challenge in healthcare, especially among young adults. Given the severity of patient pain and the risks associated with excessive opioid use, managing acute pain in trauma centers is inherently complex. This study aims to investigate the application and benefits of ultrasound-guided nerve blocks for early pain management in patients with extremity trauma positioned supine. METHODS A comprehensive literature review was conducted to assess the effectiveness and advantages of ultrasound-guided peripheral nerve blocks in the acute pain management of extremity trauma patients in the supine position. Special emphasis was placed on evaluating the selection criteria, indications, contraindications, adverse reactions, and potential complications associated with these nerve block techniques. RESULTS Ultrasound-guided nerve blocks represent a safer and more precise option for managing pain in extremity trauma patients placed in the supine position. These techniques offer significant advantages in terms of reducing healthcare expenses, diminishing reliance on opioid medications, and mitigating opioid-related complications. Nonetheless, challenges may arise due to the necessity for patient cooperation during specific nerve block procedures. CONCLUSION Ultrasound-guided nerve blocks present a promising avenue for early pain management in extremity trauma patients positioned supinely. Their implementation can lead to improved patient outcomes by alleviating pain severity, reducing opioid consumption, and cutting down healthcare costs. Further research and clinical integration of these techniques is imperative to enhance pain management protocols in trauma centers.
Collapse
Affiliation(s)
- Yuefeng Huaguo
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Shuai Kang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China
| | - Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing City, 314000, China.
- Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, China.
| |
Collapse
|
3
|
Shinde V, Penmetsa P, Dixit Y. Application of Nerve Blocks in Upper and Lower Extremity Trauma Patients Presenting to the Emergency Department of a Tertiary Care Hospital: A Prospective Observational Study. Cureus 2024; 16:e65664. [PMID: 39205782 PMCID: PMC11353552 DOI: 10.7759/cureus.65664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Pain related to trauma is often severe and undergoes undertreated in many patients. Peripheral nerve blocks provide analgesia, which is site-specific and devoid of any systemic adverse effects. Regional anesthesia may also confer several other advantages including decreased length of stay in the emergency department and improved comfort and safety for emergency procedures compared to conventional analgesia. This study aims to evaluate the feasibility of the application of nerve blocks in upper and lower extremity trauma patients presenting to the Emergency Department of a tertiary care hospital. Methodology We conducted a prospective observational study in the Department of Emergency Medicine (EM) at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune between 2023 and 2024. As a part of this research proposal, we intended to study the application of nerve blocks in upper and lower extremity trauma among patients presenting with upper and lower extremity trauma to the ED during the study period. After institutional Ethics Committee approval and informed written consent, 95 patients aged above 18 years presenting with upper and lower extremity trauma within 12 hours were selected. Patients under 18 years old, those with a history of coagulopathies, patients with open fractures, and pregnant patients were excluded from the study. Results The study comprised 95 participants, with diverse age groups represented. Among them, 26% were under 25 years old, 54% fell between the ages of 26 and 30, and 20% were over 30 years old. Gender distribution showed 64.2% male and 35.8% female participants. In terms of injury nature, the majority experienced injuries from motor vehicle crashes (31.5%) and domestic incidents (22.1%), followed by workplace injuries (15.8%), sports injuries (14.7%), falls from heights (7.4%), and assault (7.4%). The time required for interventions varied, with 41.1% of cases completed in five minutes or less, while in 58.9% of instances, more than five minutes were necessary. Similarly, the time taken for pain relief post-intervention was reported, with 66.3% experiencing relief within five minutes and 33.7% requiring more than five minutes. On initial presentation, the mean VAS score was 8.8 with an SD of 1.1, indicating high levels of pain. Following the block, there was a significant reduction in pain, with the mean VAS score dropping to 1.9 and an SD of 1.2. This change was statistically significant with a p-value of less than 0.001, indicating a substantial improvement in pain levels post-block administration. Regarding the duration of pain relief, a similar pattern emerged, with 77.8% reporting relief lasting three hours or less, and 22.2% experiencing relief for more than three hours. Conclusion In emergency situations, our research showed that peripheral nerve blocks are a very useful tool for treating pain from trauma to the upper and lower extremities. These blocks significantly reduce pain and have a long-lasting effect. Further research with larger, multi-center trials is needed to validate these findings and explore long-term outcomes.
Collapse
Affiliation(s)
- Varsha Shinde
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Pranay Penmetsa
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Yash Dixit
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| |
Collapse
|
4
|
Dutton RP, Varon AJ. Five Decades of Trauma Anesthesiology. Anesth Analg 2023; 136:949-956. [PMID: 37058732 DOI: 10.1213/ane.0000000000006099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
We present a brief history of the scientific and educational development of trauma anesthesiology. Key milestones from the past 50 years are noted, as well as the current standing of the subspecialty and prospects for the future.
Collapse
Affiliation(s)
- Richard P Dutton
- From the Department of Anesthesiology, Texas A&M College of Medicine, Dallas, Texas
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, Florida
| |
Collapse
|
5
|
Patton JW, Burton BN, Milam AJ, Mariano ER, Gabriel RA. Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients. Int Anesthesiol Clin 2023; 61:8-15. [PMID: 36398629 DOI: 10.1097/aia.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John W Patton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Rodney A Gabriel
- Divisions of Regional Anesthesia and Perioperative Informatics, Department of Anesthesiology, University of California San Diego, San Diego, California
- Department of Biomedical Informatics, University of California San Diego, San Diego, California
| |
Collapse
|
6
|
Regional anesthesia and analgesia for trauma: an updated review. Curr Opin Anaesthesiol 2022; 35:613-620. [PMID: 36044292 DOI: 10.1097/aco.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW This narrative review is an updated summary of the value of regional anesthesia and analgesia for trauma and the special considerations when optimizing pain management and utilizing regional analgesia for acute traumatic pain. RECENT FINDINGS In the setting of the opioid epidemic, the need for multimodal analgesia in trauma is imperative. It has been proposed that inadequately treated acute pain predisposes a patient to increased risk of developing chronic pain and continued opioid use. Enhanced Regional Anesthesia techniques along with multimodal pain therapies is thought to reduce the stress response and improve patient's short- and long-term outcomes. SUMMARY Our ability to save life and limb has improved, but our ability to manage acute traumatic pain continues to lag. Understanding trauma-specific concerns and tailoring the analgesia to a patient's specific injuries can increase a patient's immediate comfort and long-term outcome as well.
Collapse
|
7
|
Hernandez N, de Haan JB. Regional Anesthesia for Trauma in the Emergency Department. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Sivasankar A, Srinivasarangan M, Prasad Shetty B, Patil A. Utility of ultrasound-guided erector spinae plane block in patients presenting to the emergency department with rib fractures. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_90_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Puype L, Desmet M, Helsloot D, Van Belleghem V, Verelst S. The use of peripheral nerve blocks for trauma patients: a survey in Belgian emergency departments. Eur J Emerg Med 2021; 28:402-403. [PMID: 34433790 DOI: 10.1097/mej.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Puype
- Department of Emergency Medicine, University Hospitals KU Leuven, Leuven
| | | | - Dries Helsloot
- Department of Emergency Medicine, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | | | - Sandra Verelst
- Department of Emergency Medicine, University Hospitals KU Leuven, Leuven
| |
Collapse
|
10
|
Fortune S, Frawley J. Optimizing Pain Control and Minimizing Opioid Use in Trauma Patients. AACN Adv Crit Care 2021; 32:89-104. [PMID: 33725102 DOI: 10.4037/aacnacc2021519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Adverse effects of opioids and the ongoing crisis of opioid abuse have prompted providers to reduce prescribing opioids and increase use of multiple nonpharmacologic therapies, nonopioid analgesics, and co-analgesics for pain management in trauma patients. Nonopioid agents, including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, central α2 agonists, and lidocaine, can be used as adjuncts or alternatives to opioids in the trauma population. Complementary therapies such as acupuncture, virtual reality, and mirror therapy are modalities that also may be helpful in reducing pain. Performing pain assessments is fundamental to identify pain and evaluate treatment effectiveness in the critically ill trauma patient. The efficacy, safety, and availability of opioid-sparing therapies and multimodal pain regimens are reviewed.
Collapse
Affiliation(s)
- Shanna Fortune
- Shanna Fortune is Advanced Practice Registered Nurse, Trauma Acute Pain Management Service, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Jennifer Frawley
- Jennifer Frawley is Trauma Critical Care Clinical Pharmacy Specialist, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| |
Collapse
|
11
|
Patel MK, Muir J. Part I: Anesthesia and ventilator management in critical care patients. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Jaffe E, Patzkowski MS, Hodgson JA, Foerschler DL, Gonzalez SC, Giordano NA, Scott-Richardson MP, Highland KB. Practice Variation in Regional Anesthesia Utilization by Current and Former U.S. Military Anesthesiology Residents. Mil Med 2021; 186:e98-e103. [PMID: 33038251 DOI: 10.1093/milmed/usaa269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Per Joint Trauma System guidelines, military anesthesiologists are expected to be ready to lead an Acute Pain Service with regional anesthesia in combat casualty care. However, regional anesthesia practice volume has not been assessed in the military. The objective of this study was to assess regional anesthesia utilization among current residents and graduates of U.S. military anesthesiology residency programs.
Materials and Methods
All current and former active duty military anesthesiology program residents, trained at any of the four military anesthesiology residency programs between 2013 and 2019, were anonymously surveyed about their regional anesthesia practice. Bivariate statistics described the total single-injection and catheter block techniques utilized in the last month. Cluster analysis assessed for the presence of distinct practice groups within the sample. Follow-up analyses explored potential associations between cluster membership and other variables (e.g., residency training site, residency graduation year, overall confidence in performing regional anesthesia, etc.). This protocol received exemption determination separately from each site’s institutional review board.
Results
Current and former residents reported broad variation in regional anesthesia practice and clustered into four distinct practice groups. Less than half of respondents utilized a moderate to high number of different single-injection and catheter blocks.
Conclusions
These findings highlight the need for creative solutions to increase regional anesthesia training in military anesthesiology programs and continued ability to implement skills, such that all military anesthesiologists have adequate practice for deployed responsibilities.
Collapse
Affiliation(s)
- Edward Jaffe
- School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | | | - John A Hodgson
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Derek L Foerschler
- Department of Anesthesia, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Sara C Gonzalez
- Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Nicholas A Giordano
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation Inc., Rockville, MD 20852, USA
| | - Maya P Scott-Richardson
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation Inc., Rockville, MD 20852, USA
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation Inc., Rockville, MD 20852, USA
| |
Collapse
|
13
|
Pain Management in the Unstable Trauma Patient. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Is there a place for regional anesthesia in nonoperating room anesthesia? Curr Opin Anaesthesiol 2020; 33:561-565. [DOI: 10.1097/aco.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury 2020; 51 Suppl 2:S28-S36. [PMID: 31079833 DOI: 10.1016/j.injury.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.
Collapse
Affiliation(s)
- Daniel M Gessner
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - Jean-Louis Horn
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St., Mailcode 6342, Redwood City, CA, 94063, USA.
| |
Collapse
|
16
|
|
17
|
Odom M, Byrnes J, Herrman NWC, Micheller D, Seleno N, Majkrzak A. A Low-Fidelity, High-Functionality Ultrasound-Guided Serratus Plane Block Model. J Emerg Med 2019; 57:844-847. [PMID: 31708313 DOI: 10.1016/j.jemermed.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Thoracic injuries present many challenges for management in the acute and inpatient settings, including achieving appropriate pain control. Traditional modalities, such as opioids and spinal epidural anesthesia, are associated with multiple complications. Ultrasound-guided regional nerve blocks are becoming more prevalent, and they have been shown to be an effective modality of pain control for other traumatic injuries. Models comprised of animal tissue to simulate human anatomy are widely utilized to facilitate training of needle-guided procedures, but no such model for the serratus anterior plane block has yet been defined in the literature. OBJECTIVES Our goal was to produce a high-functionality serratus anterior plane block model with reasonable anatomic fidelity from low-cost materials. DISCUSSION We describe the creation of an inexpensive high-functionality serratus anterior plane block model from common materials, including pork ribs and chicken breasts, to realistically simulate human anatomy, including multiple muscle and fascial planes, as well as to allow hydrodissection. CONCLUSIONS This model will facilitate training and can improve success when caring for patients with thoracic trauma.
Collapse
Affiliation(s)
- Mitchell Odom
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - James Byrnes
- Clinical Simulation Program for the Advancement of Patient Safety, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Nicholas W C Herrman
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Daniel Micheller
- Department of Emergency Medicine, United States Air Force Langley Hospital, Hampton, Virginia
| | - Nicole Seleno
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| | - Allen Majkrzak
- Department of Emergency Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan
| |
Collapse
|
18
|
Mazingi D, Mbanje C, Muguti GI, Chitiyo ST. A Case Report of a Bite From the Nile Crocodile (Crocodylus niloticus) Managed with Regional Anesthesia. Wilderness Environ Med 2019; 30:441-445. [PMID: 31653551 DOI: 10.1016/j.wem.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
Crocodile attack injuries plague communities near bodies of water and continue to be an infrequent but significant form of trauma encountered in our medical facility. Regional anesthesia techniques are a novel adjunct to treatment and may facilitate simplified definitive management and better utilization of constrained operating room resources. We report a case of an adult male who presented with a large lower extremity wound after a crocodile bite. The patient was managed with initial debridement and irrigation and serial wound care entirely under regional anesthesia at the bedside. The patient did not develop wound infection, eventually receiving a skin graft with good functional outcomes. Regional anesthesia techniques are increasingly being used in the trauma setting, and their versatility allows for their use in multiple settings, by practitioners with limited experience and in resource-limited environments. No specific guidelines exist for performance of neuraxial techniques in the setting of animal bite injuries, but concerns about infectious complications have been raised. Regional anesthesia techniques may be useful in the management of extremity trauma due to crocodile attacks without infectious complications. They may reduce utilization of theatre resources and reduce opioid requirements.
Collapse
Affiliation(s)
- Dennis Mazingi
- College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe.
| | - Chenesa Mbanje
- College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Godfrey I Muguti
- College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Sabastain T Chitiyo
- College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| |
Collapse
|
19
|
Saranteas T, Koliantzaki I, Savvidou O, Tsoumpa M, Eustathiou G, Kontogeorgakos V, Souvatzoglou R. Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations. Minerva Anestesiol 2019; 85:763-773. [DOI: 10.23736/s0375-9393.19.13145-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|