The impact of regional analgesia on pain intensity and cortisolemia levels in wounded patients with combat trauma of the extremities

Abstract

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.