长时间空中医疗后送期间区域麻醉用于镇痛的经验

Carness Jeffrey M, Wilson Melissa A, Lenart Mark J, Smith Danny E, Dukes Susan F

Aerosp Med Hum Perform. 2017 Aug 1;88(8):768-772. doi: 10.3357/AMHP.4760.2017.

INTRODUCTION

There is much debate regarding the appropriate analgesic management of patients undergoing medical evacuation following combat trauma. Our primary objective was to review the utility of regional anesthetic techniques in patients undergoing aeromedical evacuation following surgical limb amputation as treatment for combat trauma.

METHODS

This study was conducted as an observational retrospective cohort whereby acutely injured amputee patients were identified via the U.S. Transportation Command's patient movement database. The Theater Medical Data Store was cross-referenced for additional patient care data including opioid consumption, duration of regional technique, pain scores, and rates of intubation.

RESULTS

Eighty-four records were retrieved from the Theater Medical Data Store. All 84 patients were victims of improvised explosive device detonation requiring limb amputation and subsequent transport from Kandahar Airfield or Camp Bastion, Afghanistan, to the United States. The majority of interventions remained in place throughout the evacuation process. A significant decrease in opioid consumption in patients receiving regional anesthesia was identified at each leg of the medical evacuation process. Pain scores were sporadically reported and not statistically different. Higher rates of intubation were identified in the nonregional anesthetic group.

DISCUSSION

Our analysis demonstrates the feasibility and effectiveness of applying regional anesthetic techniques for pain management to our combat wounded trauma patients throughout multiple stages of aeromedical evacuation. Benefits include the potential for less sedation and less opioid consumption while potentially foregoing the requirement for intubation during transport.Carness JM, Wilson MA, Lenart MJ, Smith DE, Dukes SF. Experiences with regional anesthesia for analgesia during prolonged aeromedical evacuation. Aerosp Med Hum Perform. 2017; 88(8):768-772.

引言

对于战斗创伤后接受医疗后送的患者，合适的镇痛管理存在诸多争议。我们的主要目标是评估区域麻醉技术在因战斗创伤接受手术截肢后进行空中医疗后送的患者中的效用。

方法

本研究为观察性回顾性队列研究，通过美国运输司令部的患者转运数据库识别急性受伤的截肢患者。对照战区医疗数据存储库获取更多患者护理数据，包括阿片类药物消耗量、区域技术持续时间、疼痛评分和插管率。

结果

从战区医疗数据存储库中检索到84条记录。所有84名患者均为简易爆炸装置爆炸的受害者，需要截肢，随后从阿富汗坎大哈机场或巴斯蒂安营地转运至美国。在整个后送过程中，大多数干预措施仍然有效。在医疗后送过程的每个阶段，接受区域麻醉的患者阿片类药物消耗量均显著下降。疼痛评分报告较少，无统计学差异。非区域麻醉组的插管率较高。

讨论

我们的分析表明，在多个空中医疗后送阶段，将区域麻醉技术应用于战斗受伤创伤患者的疼痛管理是可行且有效的。益处包括可能减少镇静和阿片类药物消耗，同时可能无需在转运期间进行插管。卡恩斯JM、威尔逊MA、莱纳特MJ、史密斯DE、杜克斯SF。长时间空中医疗后送期间区域麻醉镇痛的经验。航空航天医学与人类表现。2017；88(8):768 - 772。