The critically ill patient and regional anesthesia.
OBJECTIVE
The review presents an overview of indications, limitations and practical aspects of regional anesthesia and analgesia in critically ill medical and surgical patients.


RESULTS
A Medline search from 1966 to 2006 with the search terms regional anesthesia, regional analgesia, critically ill and nerve blocks, as well as a search of the Cochrane Library, revealed no studies specifically designed to evaluate the use of regional anesthesia and analgesia in the intensive care unit setting. The available evidence is limited to case reports, cohort studies and expert opinions, and relies heavily on extrapolation from studies primarily designed to examine intraoperative management of surgical patients in whom an intensive care unit admission was part of the perioperative course.


CONCLUSIONS
Regional anesthesia and analgesia in the critically ill can help to improve respiratory function, bowel function, mental status and patient comfort secondary to its opioid-sparing effects. Limitations for the use of regional anesthetic techniques are mainly associated with bleeding risks, hemodynamic side-effects, difficulties in neurologic assessment and the potential of local anesthetic toxicity.
Schulz-Stübner
Sebastian
S
Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. sebastian-schulz-stubner@uiowa.edu
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local; D002408:Catheters, Indwelling; D003422:Critical Care; D006801:Humans; D007278:Injections, Spinal; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local