Gadsden Jeff, Warlick Alicia
Department of Anesthesiology, Duke University, Durham, NC, USA.
Local Reg Anesth. 2015 Aug 12;8:45-55. doi: 10.2147/LRA.S55322. eCollection 2015.
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.
创伤是一个重大的健康问题，也是所有年龄组死亡的主要原因。与创伤相关的疼痛通常很严重，但在创伤人群中往往治疗不足。阿片类药物被广泛用于治疗受伤患者的疼痛，但在多发伤患者中会产生广泛的不良影响，如神经和呼吸功能损害以及谵妄。相比之下，区域镇痛能提供出色的部位特异性疼痛缓解，且无主要副作用，可减少创伤患者对阿片类药物的需求，并且安全且易于实施。已显示区域镇痛技术有益（包括发病率和死亡率优势）的特定人群包括肋骨骨折、股骨和髋部骨折患者以及接受断指再植的患者。急性骨筋膜室综合征是软组织损伤潜在的毁灭性后遗症，会使高能损伤（如胫骨近端骨折）复杂化。在有骨筋膜室综合征风险的患者中使用区域麻醉存在争议；尽管数据稀少，但没有证据表明外周神经阻滞会延迟诊断，而且这些技术实际上可能有助于识别病理性突破性疼痛。如果尽早开始实施区域镇痛，其益处可能最显著，并且在急诊室和现场进行神经阻滞已被证明能提供高质量的疼痛缓解且安全性良好。
