Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report

Area of Science:

• Anesthesiology
• Regional Anesthesia

Background:

• Continuous peripheral nerve blocks (CPNBs) offer prolonged analgesia but optimal durations are debated.
• Supraclavicular brachial plexus blocks target the shoulder, arm, and hand.
• The Lateral, Intermediate, and Medial (LIM) femoral cutaneous nerve block targets thigh analgesia while preserving motor function.

Observation:

• A complex traumatic degloving injury necessitated extensive surgical intervention.
• Simultaneous unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) were employed.
• This approach provided sustained analgesia throughout multiple surgical procedures.

Findings:

• The combined CPNB strategy successfully managed severe pain post-trauma.
• Prolonged continuous infusions were safely utilized for both upper and lower extremity blocks.
• The analgesic regimen significantly reduced reliance on opioids.

Implications:

• This case highlights the potential for extended CPNB use in complex trauma management.
• Effective regional anesthesia can mitigate risks associated with chronic opioid use and opioid-induced side effects.
• Preservation of quadriceps strength with the LIM block facilitates early patient mobilization and recovery.