Intérêts des anesthésies locorégionales périphériques en milieu périlleux

Abstract

Traumatic injuries associated with adventure sports activities occur often in hostile environment. The regional anesthesia (RA) outside of the hospital settings has been demonstrated but not in hostile environment. So, we wondered if it was possible to carry out these RA for these very painful traumatized patients on the accident site and during their extraction-evacuation by helicoper. In a prospective observational study, 13 patients (6 women, 13 men) who benefited from a RA were included with types of accident and injuries. RA was determined and 3 situations were defined (impossible, difficult more than 1 attempt, easy to perform). Pain evaluated using visual analog scale (VAS) (0–10) measured at rescue team arrival (T0), ten minutes after RA (T10), after reduction and at helicopter evacuation. The type of accident was 14 skiing, 1 spelunking, 2 mountaineering, 1 snowshoeing, 1 paragliding and represented 11 fractures femurs, 3 legs, and 1 hand, 1 dislocation patella, 3 shoulders. Nineteen RA performed with 6 fascia iliaca blocks, 6 femoral nerve blocks, 3 interscalene blocks, 1 multiblock of nerve (median, radial, ulnar) at elbow and 3 sciatic nerve blocks. Seventeen blocks (89%) were technically straightforward and 2 (11%) difficult. Evaluation of pain showed an average VAS of 8 (7–9) before RA (T0), 1 (0–2) at T10, 0,4 (0–1) at T reduction and 0,3 (0–1) at T evacuation. All the pathologies were treated on place and helicopter evacuations were conducted in calm atmosphere. RA performed in difficult environment is feasible, effective and reproducible in extreme conditions. There is no limitation due to hostile terrain. RA techniques used must simple and fast but performed by trained physicians who are technical experts in order achieve a successful outcome in difficult terrain.