Analgezja z wykorzystaniem technik znieczulenia przewodowego w ratownictwie górskim

*Sylweriusz Kosiński

Summary
Background.Regional anaesthesia techniques, though seldom used at the site of an accident, can provide fast and reliable pain relief in trauma patients. We describe two cases of regional blocks performed in prehospital settings, during rescue operations in a mountain area.
Case report 1. A 20-year-old hiker dislocated his right patella after falling over on a marked mountain path. The rescue team reached the site of the accident by helicopter. The victim rated his pain level at 7 points on the numeric rating scale (NRS), with no improvement after 100 ?g intravenous fentanyl. A fascia illiaca compartment block, with 25 ml of 1.5% lidocaine, resulted in a decrease of the NRS score to 2-3 and spontaneous reposition of the patella.
Case report 2. A 50-yr-old woman had broken her left tibia after slipping on wet rock on a marked path. Due to strong winds, fog and bad visibility, the helicopter could not reach the site of the accident. About 2.5 h after the accident, the rescue team reached the hypothermic victim who had a visible deformity just above her left ankle. She rated her pain level at 6 NRS. About 45 min earlier, she had taken 1000 mg of paracetamol orally. A popliteal block with 30 ml of 1% lidocaine via a 22 G spinal needle was performed, resulting in satisfactory analgesia. During more than two hours of overland transportation on a stretcher, the victim was relaxed and did not report discomfort. During the second stage of evacuation by ambulance, when the block was wearing off, she received 100 mg of tramadol intramuscularly, with poor result.
Discussion and conclusions. This is the first report on the use of regional techniques in the mountain area of Poland. In both cases, adequate uncomplicated analgesia was achieved. In certain circumstances, local analgesia can be more effective and useful than other methods of analgesia in the prehospital setting, if performed by an expert in this field.

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