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Improving Thoracic Trauma Care: Locoregional Analgesia in the Intensive Care Unit.

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Intensive Care Unit, Unidade Local Saúde Viseu Dão-Lafões, Viseu, PRT.

Introduction:  Pain management in thoracic trauma patients has, historically, relied heavily on systemic analgesic approaches, mostly opioids, associated with numerous adverse effects. Locoregional anesthesia/analgesia (LRAA), presents a promising alternative by specifically targeting pain pathways at the injury site.

Methods:  This study investigates the impact of LRAA on pain management and clinical outcomes in thoracic trauma patients within an ICU setting.

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Background: Various regional anesthesia techniques have been studied for blunt chest wall trauma over the past decades, but their impact on patient outcomes remains unclear. This systematic review and Bayesian network meta-analysis aimed to identify the most effective regional anesthesia techniques for different outcomes in blunt thoracic trauma patients.

Methods: We searched Medline, EMBASE, Scopus, and Cochrane databases for randomized controlled trials comparing regional anesthesia techniques (thoracic epidural, erector spinae plane block, serratus anterior plane block, intercostal block, paravertebral block, intrapleural block, retrolaminar block) and standard intravenous analgesia.

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Background: The gold standard of care for patients with severe peripheral nerve injury is autologous nerve grafting; however, autologous nerve grafts are usually limited for patients because of the limited number of autologous nerve sources and the loss of neurosensory sensation in the donor area, whereas allogeneic or xenografts are even more limited by immune rejection. Tissue-engineered peripheral nerve scaffolds, with the morphology and structure of natural nerves and complex biological signals, hold the most promise as ideal peripheral nerve "replacements".

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Article Synopsis
  • Intraoperative neuromonitoring (IONM) is essential for ensuring patient safety during scoliosis surgery by monitoring spinal cord and nerve function through motor-evoked potentials (MEPs), with anesthesia type affecting the accuracy of these signals.
  • A systematic review was carried out, analyzing studies from major medical databases, which evaluated the impact of various anesthetic techniques on neuromonitoring during scoliosis procedures, narrowing down from 998 articles to 45 for detailed analysis.
  • The findings suggest that the Erector Spinae Plane Block (ESPB) offers significant advantages over traditional spinal and epidural anesthesia by improving neuromonitoring accuracy, reducing complications, and providing effective pain management, leading to better patient outcomes.
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Aim: There is a lack of consensus regarding the efficacy of thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) for postoperative pain in randomized controlled trials (RCTs). The comparison of TPVB and ESPB was explored through a systematic review and meta-analysis (MA) of relevant RCTs.

Methods: A comprehensive search of relevant literature was conducted using databases such as PubMed, Embase, and MEDLINE, from 2019 to June 2024.

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