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Acute Situations: Trauma in Surgical Specialties

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Essentials of Regional Anesthesia

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Abstract

Pain is the most common symptom reported by trauma patients entering the Emergency Department. Treatment has a crucial role in trauma, since adequate pain management leads not only to increased patient comfort and satisfaction, but also to reduced morbidity (such as pulmonary complications or thromboembolic events), shorter length of stay, and improved long-term outcomes. Unfortunately, multiple studies have reported that trauma-related pain is still inadequately controlled. Loco-regional anesthesia, e.g., peripheral nerve blocks, is emerging as an important technique that can be applied at the patient admission to the Emergency Department, and maintained through the perioperative setting. Regional anesthesia can become the first choice of analgesia in patients with isolated orthopedic injuries and burning injuries because this technique is devoid of many adverse effects associated with systemic opioids. Brachial plexus blocks can provide excellent analgesia for upper extremity trauma; lumbar plexus block and sciatic nerve block, both performed at different sites, can be used for lower extremity fractures, while epidural, paravertebral, intercostal, and interpleural block can provide analgesia for thoracic trauma. Some peculiar features of the trauma patients, such as acute blood loss, trauma associated coagulopathy, and the threat of compartment syndrome, must be kept in mind and pose an extra challenge to the choice of the optimal pain management technique.

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Author information

Authors and Affiliations

  1. Department of Anesthesia, Intensive Care and Pain Management, Rizzoli Orthopedic Institute, Bologna, Italy

    Sandra Giannone MD & Daniela Ghisi MD

  2. Department of Anesthesiology and Pain Management, Policlinico Sant’Orsola-Malpighi, Bologna, Italy

    Andrea Fanelli MD

  3. Department of Anesthesia and AIPPS, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Carl C. Rest MD

Authors
  1. Sandra Giannone MD
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  2. Daniela Ghisi MD
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  3. Andrea Fanelli MD
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  4. Carl C. Rest MD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    How many deaths in the USA are caused by traumatic injuries every year?

    1. (a)

      100,000

    2. (b)

      500,000

    3. (c)

      1,000,000

    4. (d)

      250,000

    5. (e)

      25,000

  2. 2.

    Which percentage of deaths is caused by traumatic injuries worldwide?

    1. (a)

      0.1%

    2. (b)

      8%

    3. (c)

      25%

    4. (d)

      0.25%

    5. (e)

      12%

  3. 3.

    In which percentage of patients’ inadequate pain control resulted in chronic pain syndromes after spinal cord injuries?

    1. (a)

      20%

    2. (b)

      30%

    3. (c)

      40%

    4. (d)

      50%

    5. (e)

      70%

  4. 4.

    In the recent study by Whipple et al. [13] about adequacy of pain treatment in patients with multiple trauma injuries, which percentage of patients rated pain as moderate to severe?

    1. (a)

      24%

    2. (b)

      10%

    3. (c)

      0.2%

    4. (d)

      74%

    5. (e)

      99%

  5. 5.

    Which upper extremity block can have Horner’s syndrome as a complication?

    1. (a)

      Axillary block

    2. (b)

      Infraclavicular block

    3. (c)

      Supraclavicular block

    4. (d)

      Interscalene block

    5. (e)

      Ulnar block at the elbow

  6. 6.

    In lower extremity musculoskeletal trauma, acute compartment syndrome is a potentially devastating complication, whose incidence has been previously described as:

    1. (a)

      7.3 per 100,000 in men and 0.7 per 100,000 in women

    2. (b)

      0.7 per 100,000 in women and 7.3 per 100,000 in men

    3. (c)

      30 per 100,000 in men and women

    4. (d)

      0.5 per 100,000 in men and 0.01 per 100,000 in women

    5. (e)

      70 per 100,000 in men and women

  7. 7.

    The most common cause of acute compartment syndrome is usually:

    1. (a)

      Burn injury

    2. (b)

      Soft tissue injury

    3. (c)

      Fracture

    4. (d)

      Crush injury

    5. (e)

      Tissue edema

  8. 8.

    The most common fracture that can be complicated by compartment syndrome is:

    1. (a)

      Humerus fracture

    2. (b)

      Scaphoid fracture

    3. (c)

      Tibial fracture

    4. (d)

      Femur fracture

    5. (e)

      Scapular fracture

  9. 9.

    A predisposing factor for compartment syndrome in soft tissue injuries is:

    1. (a)

      Regional anesthesia

    2. (b)

      Hypertension

    3. (c)

      Anticoagulants or bleeding disorders

    4. (d)

      Hypotension

    5. (e)

      Vascular diseases

  10. 10.

    One of the earliest and most sensitive clinical signs of compartment syndrome is:

    1. (a)

      Pain out of proportion

    2. (b)

      Motor and sensory block

    3. (c)

      Paresthesia

    4. (d)

      Absence of pain

    5. (e)

      Pallor

  11. 11.

    Mortality rate of patients with single rib fractures is around:

    1. (a)

      1%

    2. (b)

      10%

    3. (c)

      6%

    4. (d)

      50%

    5. (e)

      0.1%

  12. 12.

    Mortality rate of patients with multiple rib fractures is around:

    1. (a)

      90%

    2. (b)

      80%

    3. (c)

      70%

    4. (d)

      35%

    5. (e)

      25%

  13. 13.

    The East Association for the Surgery of Trauma (EAST) stated that one of the following may improve clinically significant outcomes in this population (Grade B recommendation) and that it should be considered the preferred analgesic modality (Grade A recommendation):

    1. (a)

      Intrapleural block

    2. (b)

      Epidural block

    3. (c)

      Intercostal block

    4. (d)

      Paravertebral block

    5. (e)

      Morphine PCA

  14. 14.

    When compared to epidural, paravertebral nerve blocks have been demonstrated to cause less:

    1. (a)

      Hypotension and urinary retention

    2. (b)

      Failed block

    3. (c)

      Compartment syndrome

    4. (d)

      Foot drop

    5. (e)

      Infections

  15. 15.

    Which of the following have been demonstrated to provide comparable analgesia?

    1. (a)

      Intercostal and intrapleural blocks

    2. (b)

      Intercostal and paravertebral blocks

    3. (c)

      Epidural and intrapleural blocks

    4. (d)

      Paravertebral and epidural blocks

    5. (e)

      Paravertebral and intrapleural blocks

Answers

  1. 1.

    a

  2. 2.

    b

  3. 3.

    e

  4. 4.

    d

  5. 5.

    d

  6. 6.

    a

  7. 7.

    c

  8. 8.

    c

  9. 9.

    c

  10. 10.

    a

  11. 11.

    c

  12. 12.

    d

  13. 13.

    b

  14. 14.

    a

  15. 15.

    d

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Giannone, S., Ghisi, D., Fanelli, A., Rest, C.C. (2018). Acute Situations: Trauma in Surgical Specialties. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_22

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_22

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  • Online ISBN: 978-3-319-74838-2

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