Regional anesthesia in trauma patients

Regional anesthesia has never been more popular or in more demand by our surgical colleagues. This has resulted in resurgence in the use of regional anesthesia techniques. These techniques provide excellent perioperative analgesia that may improve patient outcome. However, these techniques present unique challenges in trauma patients and should be used with caution in uncooperative patients or those with cardiopulmonary instability. Selection of analgesic technique should depend upon the physician's experience, familiarity, and the associated complication. Careful preanesthetic evaluation with special attention to altered anatomy, coagulopathies, altered blood volume, and any restriction to supplementation or resuscitation are of prime importance. Importantly, sedative drugs must be used judiciously since over sedation may increase complications. The most common causes of complications are errors in judgment related to choice of patient, technique, drug, concentration, volume, and supplementation with sedation. Paramount to the growth of regional anesthesia in trauma surgery is a skilled anesthesiologist who encourages the performance of these techniques and educates surgeons, nurses and patients to the advantages and requirements for their success.