Stojadinovic Alexander, Auton Alyson, Peoples George E, McKnight Geselle M, Shields Cynthia, Croll Scott M, Bleckner Lisa L, Winkley James, Maniscalco-Theberge Mary E, Buckenmaier Chester C
Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Pain Med. 2006 Jul-Aug;7(4):330-8. doi: 10.1111/j.1526-4637.2006.00171.x.
The war in Iraq has resulted in a high incidence of severe extremity injury requiring multiple surgical procedures and extensive rehabilitation. We describe the use of advanced regional anesthesia to meet this significant medical challenge.
From March 2003 to December 2004, 4,100 casualties have been evacuated to Walter Reed Army Medical Center (WRAMC). Of 1,400 inpatients, 750 have been battle-injured with 500 having extremity injuries. Of these, 287 (57%) received surgical care incorporating regional anesthesia including single-injection peripheral nerve blocks and continuous peripheral and epidural infusion catheters. Wounding, surgical, anesthetic, and outcomes data have been prospectively collected.
Over 900 operations (mean 4+/-2/patient) were performed on 287 casualties prior to arrival at WRAMC, and 634 operations (mean 2+/-1/patient) were performed at WRAMC. Thirty-five percent of this cohort was amputees. In the study group, 646 advanced regional anesthesia procedures, including 361 continuous peripheral nerve blocks (CPNBs), were performed with a mean catheter infusion time of 9 days (1-34). Catheter-related complications occurred in 11.9% of casualties and were technical or minor in nature. Catheter-related infection rate was 1.9%. In 126 casualties with indwelling CPNB catheters, a significant decrease in pain score over 7 days was apparent (mean 3.7+/-0.2 to 2.2+/-0.2, P<0.001).
Advanced regional anesthetic techniques allowed for safe perioperative surgical anesthesia and analgesia in the management of the modern combat casualty.
伊拉克战争导致严重肢体损伤的发生率很高，需要进行多次外科手术和广泛的康复治疗。我们描述了使用先进的区域麻醉来应对这一重大医疗挑战的情况。
从2003年3月至2004年12月，4100名伤员被疏散到沃尔特里德陆军医疗中心（WRAMC）。在1400名住院患者中，750名是战斗受伤，其中500名有肢体损伤。在这些患者中，287名（57%）接受了包括单次注射外周神经阻滞以及连续外周和硬膜外输注导管在内的区域麻醉的外科治疗。前瞻性地收集了受伤、手术、麻醉和结果数据。
在抵达WRAMC之前，对287名伤员进行了900多次手术（平均每人4±2次），在WRAMC进行了634次手术（平均每人2±1次）。该队列中有35%为截肢者。在研究组中，进行了646例先进的区域麻醉操作，包括361例连续外周神经阻滞（CPNBs），平均导管输注时间为9天（1 - 34天）。导管相关并发症发生在11.9%的伤员中，属于技术或轻微性质。导管相关感染率为1.9%。在126名留置CPNB导管的伤员中，7天内疼痛评分明显下降（平均从3.7±0.2降至2.2±0.2，P<0.001）。
先进的区域麻醉技术为现代战斗伤员的围手术期手术麻醉和镇痛提供了安全保障。
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