PHILADELPHIA – When integrated into combat casualty care, early use of regional anesthesia appears to provide sustained pain benefits throughout rehabilitation and recovery.

That’s according to a report in Regional Anesthesia & Pain Medicine.  Corp. Michael J. Crescenz VAMC-led researchers pointed out that improving acute pain management after traumatic injury remains a priority for policymakers and clinicians as rates of injury and subsequent pain-related disability rise nationally but  innovations in trauma pain management remain understudied.1

For example, the study team – which also included leadership from the University of Pennsylvania – noted that no studies have examined the long-term benefits of regional anesthesia (RA) for pain management after combat-related injury. In response, researchers examined the relationship between RA administration and patient-reported pain-related outcomes among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) service members sustaining a combat-related extremity injury. The study was conducted in collaboration with the DoD and Veterans Center for Integrative Pain Management.

Between 2007 and 2013, 358 American military personnel injured in OEF/OIF were enrolled at two MTFs and followed for up to two years after injury. The study defined cohorts based on whether or not participants were administered RA within a week after sustaining a combat-related injury.

Results indicated that receiving early RA was associated with improved average pain over the first six months after injury (β=−0.57; p=0.012) adjusting for injury severity and length of stay at the primary treatment facility. Furthermore, the  difference was observed up to 24 months after injury (β=−0.36; p=0.046).

“Individuals receiving early RA reported greater pain relief, improved neuropathic pain intensity, and higher satisfaction with pain outcomes; however, by 24 months, mean scores did not significantly differ between cohorts,” the researchers reported.

Study authors concluded that, when administered soon after traumatic injury, RA is a valuable pain management intervention, adding, “Future longitudinal studies investigating the timely delivery of RA for optimal pain management in civilian trauma settings are needed.”

“The improvements in average pain and pain relief in the first six months after injury observed in our study indicate a strong association between receiving early RA after combat injury in the austere battlefield environment and improved long-term pain outcomes,” added co-author Rosemary Polomano, PhD, RN, FAAN, Associate Dean for Practice, Professor of Pain Practice Penn Nursing.  “These results suggest that effective, agile pain interventions initiated close to the time of injury can play an important role in reducing future pain.”

1.    Gallagher RM, Polomano RC, Giordano NA, Farrar JT, Guo W, Taylor L, Oslin D,Goff BJ, Buckenmaier CC. Prospective cohort study examining the use of regionalanesthesia for early pain management after combat-related extremity injury. RegAnesth Pain Med. 2019 Sep 27. pii: rapm-2019-100773. doi:10.1136/rapm-2019-100773. [Epub ahead of print] PubMed PMID: 31563880.