Regional Block Anaesthesia - How Effective is it for Extremity Trauma?

Regional block anaesthesia (RBA) techniques are eclipsed by the widespread use of general anaesthesia (GA), especially in trauma surgery. This is despite the numerous advantages that regional blocks have to offer. We conducted a study to evaluate efficacy, safety and feasibility of RBA in isolated extremity trauma in war scenario. A prospective study was carried out over a period of eight months. There were a total of 96 patients with splinter, mine blast and gun shot wounds. Supraclavicular or axillary brachial block was employed for upper extremity surgery. 3 in 1 femoral block with classical sciatic block at hip or popliteal fossa was administered for lower limb operations. All patients were stabilized prior to the procedure. A combination of lignocaine 3 mg/kg of 2% and bupivacaine 1.5 mg/kg of 0-5% with dilution to make a volume of 0.75 ml/kg was employed. Assessment was made for onset, duration and degree of anaesthesia. Haemodynamic parameters and oxygen saturation were measured during the peritraumatic period. 92.5% cases had good motor and sensory anaesthesia and permitted unhindered surgery without supplementation. The rest required GA/dissociative anaesthesia (DA). Post operative pain relief lasted for an average of 4-5 hours. No patient had derangement of haemodynamic parameters or oxygen saturation. There was no systemic drug toxicity, local complications or mortality in our series. We found RBA for isolated extremity trauma to be simple, safe and effective with consistent results.