Regional anesthetic blocks in patients with chest trauma
Mohamed Maher Abd El Fattah;
Abstract
Thoracic injury accounts for 25% of deaths among trauma patients. It is second only to head injury as a cause of trauma-related deaths in the United States. Rib fractures are common, and morbidity and mortality are directly correlated with the number of rib fractures.
Trauma patients demands special medical care. Pain is frequently undertreated in the early phase of trauma. 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 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 regional anesthesia 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.
Damage to the osseous structure of the thorax by rib and sternum fractures destabilizes the rib cage and impairs spontaneous breathing mechanics substantially. This condition is amplified by pain, which further reduces breathing function. Direct traumatic damage to the lung (i.e., lung contusion), in combination with a concurrent increase in vascular permeability of the lung capillaries in the injured area, leads to an extravasation of protein rich fluid with an altered surfactant composition, eventually resulting in slow but progressive respiratory failure.
Disadvantages of regional analgesia are the technical difficulties related to placement of the block, as some degree of patient cooperation is required. Indwelling catheters may also be an infection risk and can be dislodged.
Trauma patients demands special medical care. Pain is frequently undertreated in the early phase of trauma. 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 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 regional anesthesia 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.
Damage to the osseous structure of the thorax by rib and sternum fractures destabilizes the rib cage and impairs spontaneous breathing mechanics substantially. This condition is amplified by pain, which further reduces breathing function. Direct traumatic damage to the lung (i.e., lung contusion), in combination with a concurrent increase in vascular permeability of the lung capillaries in the injured area, leads to an extravasation of protein rich fluid with an altered surfactant composition, eventually resulting in slow but progressive respiratory failure.
Disadvantages of regional analgesia are the technical difficulties related to placement of the block, as some degree of patient cooperation is required. Indwelling catheters may also be an infection risk and can be dislodged.
Other data
| Title | Regional anesthetic blocks in patients with chest trauma | Other Titles | التخدير المنطقي في مرضى اصابات الصدر | Authors | Mohamed Maher Abd El Fattah | Issue Date | 2014 |
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