Ryan Perlman1, Sam Bonge2. 1. Division of Trauma Anesthesia, Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA. ryan.perlman@cshs.org. 2. Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA.
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.
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.
Authors: Roman Kosir; Frederick A Moore; John H Selby; Christine S Cocanour; Rosemary A Kozar; Ernest A Gonzalez; S Rob Todd Journal: J Trauma Date: 2007-08