Regional anaesthesia for trauma: an update

Abstract

The term trauma has Greek origins, meaning ‘wound’. Trauma represents a major global health burden, with significant morbidity, mortality, and socioeconomic impact. Injuries vary in aetiology, distribution, severity, and prognosis. Worldwide, millions are injured, disabled, or killed each year. Falls, burns, violence, and road traffic accidents are among the most significant causes stated by the World Health Organization. Acute phase resuscitation has improved dramatically after introduction of Advanced Trauma Life Support (ATLS w ) algorithms. The result is a reduction in mortality rates, but comparatively more victims progressing to long-term disability. Regional nerve block is contentious in the context of trauma. Historical reports apportion blame to regional interventions as contributing to poor outcomes in particular patients, such as those at risk of compartment syndrome. Traditional aversion is now being questioned. A growing evidence base from military and civilian sources is supportive of a greater role for regional anaesthesia (RA) in the management of trauma casualties. Optimized pain control may improve outcome in such patients. This article aims to clarify the current evidence, address common controversies, and provide a summary of the advancing role of RA in the trauma setting.