Regional anesthesia in the austere environment: Lessons learned from current out-of-hospital practice

Anderson, Nathan D., Shaner, Julie L., Braunecker, Stefan and Potter, Lydia G. 2024. Regional anesthesia in the austere environment: Lessons learned from current out-of-hospital practice. Wilderness & Environmental Medicine 35 (2) , pp. 234-242. 10.1177/10806032241231257

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Abstract

Introduction Pain management for trauma in the extreme environment is vital for both casualty comfort and aiding safe extrication. However, adequate pain management in a resource-limited environment can be challenging and is often limited. We conducted a scoping review of the use of regional anesthesia in the prehospital environment, evaluating which regional anesthetic procedure was performed for various indications, their efficacy, and the type of healthcare provider delivering the anesthetic. Methods A PRISMA-guided systematic literature review was conducted of Medline, Embase, and Cochrane databases for studies reporting the use of regional anesthesia in the prehospital environment published before June 30, 2022. Results Thirty studies met the criteria and were included in the review. The most common types of regional anesthesia were fascia-iliaca compartment block ( n = 317, from 12 studies) and femoral nerve block ( n = 210, from 8 studies), along with various other blocks for a range of indications. These blocks had good efficacy and a low-risk profile and could be delivered by a wide range of healthcare providers. Conclusions Regional anesthesia is an effective and non-resource-heavy pain management tool in prehospital environments, which may be applicable to austere settings. It can cover a wide range of injuries and can avoid systemic complications for casualties that may already be challenging to manage in out-of-hospital settings. Additionally, regional anesthesia can be effectively delivered by a wide range of providers. This review provides a holistic summary of pain management using regional anesthesia in the prehospital environment, with a discussion on its potential use in more extreme settings.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	SAGE Publications
ISSN:	1080-6032
Last Modified:	28 Oct 2024 16:15
URI:	https://orca.cardiff.ac.uk/id/eprint/173483

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