There is uncertainty of evidence regarding the effectiveness and safety of regional analgesic blocks during emergency care
for wounded patients with combat trauma of the extremities at Role 2 medical treatment facilities and during interhospital transportation.
Objective. To optimize perioperative analgesia regimens for wounded patients with combat trauma of the extremities at Role 2 medical
treatment facilities and during interhospital transportation based on a comparative assessment of the impact of regional or systemic analgesia
on pain intensity and cortisolemia levels over time.
Materials and Methods. A prospective study included 100 patients with isolated combat trauma of one extremity. Patients were divided
into two groups: Group 1 (n = 50) received systemic analgesia only, while Group 2 (n = 50) received ultrasound-guided regional anesthesia.
Pain intensity was assessed over time using a Visual Analog Scale (VAS), additionally the level of cortisol in plasma was also measured. Study
parameters were registered in four stages: 1st stage – at the time of admission to the Role 2 medical treatment facilities; 2nd stage – at the
completion of surgical intervention; 3rd stage – at the beginning of interhospital transportation; 4th stage – at the completion of interhospital
transportation.
Results. Between the 1st and 2nd stages, both groups demonstrated significant changes in VAS and Cortisol levels (p < 0.05, respectively).
At the 2nd stage, a significant intergroup difference was observed for VAS 2 (p < 0.05), whereas Cortisol 2 levels did not differ significantly
between groups (p = 0.17). Between the 2nd and 3rd stages, Group 1 showed significant changes in both VAS and Cortisol values (p < 0.05
respectively), while in Group 2 no significant change in VAS was observed (p = 0.11), despite a significant change in Cortisol levels (p < 0.05).
At the 3rd stage, intergroup differences remained significant for VAS 3 (p < 0.05), with no significant difference in Cortisol 3 levels (p = 0.41).
Between the 3rd and 4th stages, significant changes in VAS and Cortisol were observed only in Group 1 (p > 0.05 respectively), whereas no
significant changes were detected in Group 2 (p = 0.07 and p = 0.38 respectively). At the 4th stage, significant intergroup differences were
found for both VAS 4 and Cortisol 4 (p < 0.05 respectively).
Conclusions. The study results confirm that optimizing perioperative analgesia regimens at Role 2 medical treatment facilities and during
interhospital transportation allows for minimizing systemic stress response manifestations, significantly improving treatment outcomes for
wounded patients, and remains a priority task of modern military medicine.
У статті представлено результати проспективного дослідження з визначення ефективності реґіонарних аналгетичних блокад під
час надання невідкладної допомоги пораненим із бойовою травмою кінцівок в умовах шпиталів Role 2 та під час міжгоспітального
транспортування. До дослідження включено 100 поранених із бойовою травмою однієї кінцівки, яких розділено на дві групи: група
1 (n = 50) отримувала лише системну аналгезію, тоді як група 2 (n = 50) – реґіонарну анестезію, що проводилася під ультразвуковим контролем. У динаміці фіксувалась інтенсивність болю та визначався рівень плазмового кортизолу. Результати дослідження
підтверджують, що оптимізація схем періопераційного знеболювання в умовах шпиталів Role 2 та під час міжгоспітального транспортування дає можливість мінімізувати прояви системної стрес-відповіді, значно покращити результати лікування поранених та
є пріоритетним завданням сучасної військової медицини.
