Acute pain management in trauma: anatomy, ultrasound-guided peripheral nerve blocks and special considerations

Minerva Anestesiol. 2019 Jul;85(7):763-773. doi: 10.23736/S0375-9393.19.13145-8. Epub 2019 Feb 7.

Abstract

Pain is the most common complaint amongst trauma patients throughout the perioperative period. Multimodal analgesia is currently being regarded the mainstay, with regional anesthesia techniques constituting an integral part of it. Ultrasound imaging techniques display a plethora of advantages that have pervaded regional anesthesia practice. In this review, we set out to provide several examples of injuries, to elucidate the precise anatomy of fractured bones (osteotomes), and to elaborate on certain peripheral nerve blocks employed in pain management of trauma patients. Controversies/special considerations pertaining to peripheral nerve blocks also dictate thorough analysis: as such, acute compartment syndrome, acute peripheral nerve injuries, regional anesthesia in awake or anesthetized patients, continuous peripheral nerve blocks, positioning limitations and, finally, ultrasound imaging versus neurostimulation techniques are extensively reviewed.

Publication types

  • Review

MeSH terms

  • Acute Pain / etiology
  • Acute Pain / therapy*
  • Analgesia / methods*
  • Anesthesia, Conduction / methods
  • Brachial Plexus / anatomy & histology
  • Brachial Plexus / physiopathology
  • Compartment Syndromes / etiology
  • Compartment Syndromes / prevention & control
  • Emergency Medical Services
  • Fractures, Bone / complications*
  • Fractures, Bone / diagnostic imaging
  • Fractures, Bone / surgery
  • Humans
  • Lower Extremity / diagnostic imaging
  • Lower Extremity / injuries
  • Lower Extremity / innervation
  • Lower Extremity / surgery
  • Nerve Block / methods*
  • Pain Management / methods*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / therapy
  • Patient Positioning
  • Peripheral Nerve Injuries / etiology
  • Peripheral Nerve Injuries / prevention & control
  • Peripheral Nerves* / physiopathology
  • Ultrasonography, Interventional / methods
  • Upper Extremity / diagnostic imaging
  • Upper Extremity / injuries
  • Upper Extremity / innervation
  • Upper Extremity / surgery