Introduction: Peripheral nerve blocks have been widely used during the Russo-Ukrainian war due to their safety benefits during prolonged unsupervised transportation and opioid-sparing effects that are highly desirable during prolonged treatment that requires multiple surgical interventions. Sedation during minor surgical procedures is optional when regional anaesthesia is used and is often omitted due to its cost and potential adverse effects (respiratory depression, delayed patient mobilisation and risk of agitation). Previous observations suggest that combat casualties may benefit psychologically from sedation during invasive surgical procedures. This prospective observational study sought to assess the difference in stress response and pain following procedures conducted under regional anaesthesia with and without sedation.
Methods: A prospective observational study was conducted involving patients undergoing treatment of combat limb injuries. The population comprised two groups according to their preference to nerve block only (R) or nerve block plus sedation (RS). Data on previous experiences with anaesthesia were collected and blood samples were obtained before and after the procedure to measure cortisol and glucose concentrations.
Results: Mean change in cortisol was higher in group R: 27 (-3 to 82) vs 192 (111 to 249); p=0.003. There was no difference in glucose (p=0.705) or postoperative pain scores following the intervention (p=0.5), 3 hours (p=0.44), 6 hours (p=0.95) and 9 hours (p=0.1) later. Patients in group RS reported slightly greater satisfaction with anaesthesia (8.12±1.36 vs 9.06±0.92, p=0.03). Previous experiences with specific methods of anaesthesia and ketamine exposure did not affect patient choice. Deep sedation was necessary in 25% of cases in group RS (none in R), increasing the mean cost of anaesthesia by 65%.
Conclusions: Short-term pain outcomes were not affected by sedation. Postprocedure cortisol levels were higher with no sedation, with no difference in glucose levels. Satisfaction was statistically higher in patients receiving sedation alongside regional anaesthesia.
Keywords: Adult anaesthesia; Decision Making; MEDICAL ETHICS; Military Personnel; Trauma management; WOUND MANAGEMENT.
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