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Regional anesthesia in trauma patients: a quality improvement study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Traumatic injury is associated with severe pain that is often inadequately managed. Opioids remain the mainstay of pain management in this population because of their ease of use. However, opioids have significant side effects including nausea, delirium, and respiratory depression. Regional anesthesia has been demonstrated in the perioperative setting to provide superior analgesia with fewer side effects and a reduced length of stay. Similarly, regional anesthesia has been shown to improve morbidity for extremity fractures and dislocations when introduced early.

Methods

This was a prospective cohort quality improvement study evaluating the use of earlier and more consistent regional anesthesia procedures in 28 consecutive trauma patients at a large Canadian trauma center. In this quasi-experimental before and after study, we identified all trauma patients with an ISS < 15 that would have been candidates for a peripheral nerve block and compared them to the study population that received a regional anesthesia nerve block within 24 h of admission.

Results

The introduction of a multidisciplinary pain program into our level 1 regional trauma center resulted in a decrease in pain severity and opioid consumption of 55% and 61%, respectively, after 24 h of admission. Length of stay in the emergency department decreased (11.5 ± 6.9 vs. 4.9 ± 4.4 h; p < 0.01) while hospital length of stay did not (338 ± 276 vs. 285 ± 205 h; p = 0.4).

Conclusion

This quality improvement proof-of-principle study reveals the potential advantages for regional anesthesia, such as decreased emergency department use, opioid consumption, and pain severity. Further randomized trials are necessary, however, to describe a direct benefit from peripheral nerve blockade on reducing length of stay for trauma patients.

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Author information

Authors and Affiliations

  1. Division of Trauma Anesthesia, Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA

    Ryan Perlman

  2. Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA

    Sam Bonge

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  1. Ryan Perlman
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Correspondence to Ryan Perlman.

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Conflict of interest

Dr. Ryan Perlman and Dr. Sam Bonge declare that they have no conflict of interest.

Ethical approval

I, Ryan Perlman, affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted. All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This includes ethical standards in Canada where Ethics was granted for this study.

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Perlman, R., Bonge, S. Regional anesthesia in trauma patients: a quality improvement study. Eur J Trauma Emerg Surg 49, 495–504 (2023). https://doi.org/10.1007/s00068-022-02097-5

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  • DOI: https://doi.org/10.1007/s00068-022-02097-5

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