Background and Aims Regional anaesthesia remains an essential part of perioperative care. Along with excellent pain control it reduces opioid need while diminishing stress response. Despite these obvious advantages, regional anaesthesia is often underutilized in trauma patients. This is due to time management issues as well as fear of complications like masking of compartment syndrome and nerve damage. We present a case of multiple trauma patient with upper and lower extremity injuries managed solely with regional anaesthesia and sedation.
Methods 47-year- old male 75 kg presented to the emergency department after a motorcycle accident with fractures of the left femur, pelvis, right tibia and left wrist. Further radiological results were negative. The patient showed signs of upper respiratory tract infection. The perioperative plan incorporating regional anaesthesia was consented.
Results Combined spinal epidural anaesthesia was initiated for surgery of lower extremity injuries. Additionally, an infraclavicular block was performed for anaesthesia of wrist fracture. Sedation with propofol and ketamine aided with protracted operative time. The procedure was further uneventful.
Conclusions Trauma patients are more prone to long term opioid dependence. Therefore sparing opioid use and combining multiple regional techniques is a safe alternative, using low dose local anaesthetics to reduce chances of LAST. Follow up, monitoring and a multimodal analgesia plan is imperative. More evidence is needed on the effect of inflammation, wound healing, length of stay and chronic pain.
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