title: Responding to challenges in modern combat casualty care: innovative use of advanced regional anesthesia.
abstract: BACKGROUND
  The war in Iraq has resulted in a high incidence of severe extremity injury requiring multiple surgical procedures and extensive rehabilitation. We describe the use of advanced regional anesthesia to meet this significant medical challenge.
  
  
  METHODS
  From March 2003 to December 2004, 4,100 casualties have been evacuated to Walter Reed Army Medical Center (WRAMC). Of 1,400 inpatients, 750 have been battle-injured with 500 having extremity injuries. Of these, 287 (57%) received surgical care incorporating regional anesthesia including single-injection peripheral nerve blocks and continuous peripheral and epidural infusion catheters. Wounding, surgical, anesthetic, and outcomes data have been prospectively collected.
  
  
  RESULTS
  Over 900 operations (mean 4+/-2/patient) were performed on 287 casualties prior to arrival at WRAMC, and 634 operations (mean 2+/-1/patient) were performed at WRAMC. Thirty-five percent of this cohort was amputees. In the study group, 646 advanced regional anesthesia procedures, including 361 continuous peripheral nerve blocks (CPNBs), were performed with a mean catheter infusion time of 9 days (1-34). Catheter-related complications occurred in 11.9% of casualties and were technical or minor in nature. Catheter-related infection rate was 1.9%. In 126 casualties with indwelling CPNB catheters, a significant decrease in pain score over 7 days was apparent (mean 3.7+/-0.2 to 2.2+/-0.2, P<0.001).
  
  
  CONCLUSIONS
  Advanced regional anesthetic techniques allowed for safe perioperative surgical anesthesia and analgesia in the management of the modern combat casualty.
authors.affiliation: Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Alyson
authors.initials: A
authors.lastname: Auton
authors.forename: George E
authors.initials: GE
authors.lastname: Peoples
authors.forename: Geselle M
authors.initials: GM
authors.lastname: McKnight
authors.forename: Cynthia
authors.initials: C
authors.lastname: Shields
authors.forename: Scott M
authors.initials: SM
authors.lastname: Croll
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Bleckner
authors.forename: James
authors.initials: J
authors.lastname: Winkley
authors.forename: Mary E
authors.initials: ME
authors.lastname: Maniscalco-Theberge
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
mesh_terms: D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000706:statistics & numerical data*; D015897:Comorbidity; D005121:Extremities / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D019990:Perioperative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014857:Warfare; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy*