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Prospective cohort study examining the use of regional anesthesia for early pain management after combat-related extremity injury
  1. Rollin M Gallagher1,
  2. Rosemary C Polomano2,3,
  3. Nicholas A Giordano4,5,
  4. John T Farrar6,
  5. Wensheng Guo6,
  6. Lynn Taylor6,
  7. David Oslin7,8,
  8. Brandon J Goff9 and
  9. Chester C Buckenmaier4,5
  1. 1Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
  2. 2Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
  3. 3Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  4. 4Department of Military and Emergency Medicine, Uniformed Services University, Rockville, Maryland, USA
  5. 5Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland, USA
  6. 6Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  7. 7Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  8. 8Behavioral Health Department, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States
  9. 9Department of Rehabilitation Medicine, United States Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
  1. Correspondence to Dr Chester C Buckenmaier, Defense & Veterans Center for Integrative Pain Management, Rockville, Maryland 20852, USA; cbuckenmaier{at}


Background No studies have examined the long-term benefits of regional anesthesia (RA) for pain management after combat-related injury. The objective of this prospective cohort study was to examine the relationship between RA administration and patient-reported pain-related outcomes among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) service members sustaining a combat-related extremity injury.

Methods Between 2007 and 2013, n=358 American military personnel injured in OEF/OIF were enrolled at two military treatment facilities. Individuals were followed for up to 2 years after injury. Cohorts were defined based on whether participants were administered RA within 7 days after sustaining a combat-related injury, or not. Linear mixed effects models examined the association between RA and average pain intensity. Secondary outcomes included pain relief, pain interference, neuropathic pain symptoms, treatment outcomes related to pain management, and mental health symptoms.

Results Receiving early RA was associated with improved average pain over the first 6 months after injury (β=−0.57; p=0.012) adjusting for injury severity and length of stay at the primary treatment facility. This difference was observed up to 24 months after injury (β=−0.36; p=0.046). Individuals receiving early RA reported greater pain relief, improved neuropathic pain intensity, and higher satisfaction with pain outcomes; however, by 24 months, mean scores did not significantly differ between cohorts.

Conclusion Findings indicate that when administered soon after traumatic injury, RA is a valuable pain management intervention. Future longitudinal studies investigating the timely delivery of RA for optimal pain management in civilian trauma settings are needed.

Trial registration number NCT00431847

  • regional anesthesia
  • wounds and injuries
  • multiple trauma
  • pain management
  • Iraq War
  • Afghan Campaign

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  • Contributors RMG, CCB, and RP conceived the original idea of this trial, wrote the protocol, and supervised the project. Planning, execution, and data collection of the experiment were carried out by CCB, DO, BJG, RMG, and RP. NG, LT, JTF, and WG performed the statistical analyses, interpretation, visualization, and data management. All the authors equally provided critical feedback and helped to shape the research, analysis, and writing of the manuscript.

  • Funding This work was supported by the US Department of Veterans Affairs (VA RRD D45064-1).

  • Disclaimer The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Veterans Affairs, the Uniformed Services University, the Department of the Army/Navy/Air Force, the Department of Defense, the United States Government, or the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Walter Reed National Military Medical Center and San Antonio Military Medical Center institutional review boards approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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