REGIONAL ANESTHESIA AND ANALGESIA IN CRITICALLY ILL PATIENTS

Abstract

Regional anesthesia has become invaluable for the treatment of pain during and after a wide range of surgical procedures. However, its benefits in the non surgical setting have been less well studied. Regional anesthesia is an appealing modality for critically ill patients, providing focused and sustained pain control with beneficial systemic effect profiles. Indications for regional anesthesia in this patient group are not limited to surgical and postsurgical analgesia but expand to the management of trauma-related issues, medical conditions, and painful procedures at the bedside. Patients in the critical care unit present special challenges to the regional anesthesiologist, including coagulopathies, infections, immunocompromised states, sedation- and ventilation-associated problems, and factors potentially increasing the risk for systemic toxicity. This review is intended to evaluate the role of regional anesthesia in critically ill patients, to discuss potential benefits, and to provide a summary of the published evidence on the subject. The present essay aims at: 1. Presenting the various indications for which regional anesthesia can be of special use in the intensive care unit (ICU). 2. Putting particular emphasis on issues regarding specific complications, contraindications, and limitations applicable to this special patient group; and 3. Briefly recapitulating specific regional anesthetic techniques that may be used in critically ill patients Regional anesthesia can be useful in the management of large variety of conditions and procedures in critically ill patients. Although the attributes of regional anesthetic techniques could feasibly affect outcomes, no conclusive evidence supporting this assumption exists to date, and research needs to be directed toward his entity. Given current epidemiologic trends among patients seeking healthcare, specifically increasing comorbidity burdens,the proportion of patients admitted to critical care units is likely to increase significantly in the future, mandating that our specialty expand to meet their needs. Recent findings promote the safe use of most regional and neuraxial techniques in many situations, but further research is warranted to gain a better understanding f their use in the critically ill or injured.

Keywords ICU- CRITICALLY- ATLS- CNS- GABA- FAW