Effectiveness of regional analgesia in the early postoperative period in patients with mine-explosion and gunshot shrapnel injuries of the limbs: A prospective controlled study

BACKGROUND: Mine-explosion and gunshot shrapnel injuries of the limbs are accompanied by severe pain requiring effective analgesia. Comparing the analgesic efficacy of conduction anesthesia versus systemic postoperative analgesia is essential for optimizing treatment approaches, particularly under resource-constrained conditions in military medicine.

AIM: To compare the analgesic efficacy of conduction anesthesia and systemic postoperative analgesia in patients with mine-explosion and gunshot shrapnel injuries of the extremities.

METHODS: Patients (n=92) were enrolled in a prospective controlled study conducted from October 1 to December 31, 2023, at a level III military field hospital. Patients were divided into two groups based on the type of anesthesia: group 1 (n=68) underwent surgery under ultrasound-guided conduction anesthesia; group 2 (n=24) received general combined anesthesia (inhalational + non-inhalational, n=10), general non-inhalational anesthesia (n=4), or spinal anesthesia (n=10). Primary endpoints included pain intensity at rest and during movement, and the need for systemic opioid and non-opioid analgesics, assessed using the Numeric Rating Scale at 0, 3, 6, 9, 12, 15, 18, 21, and 24 h postoperatively.

RESULTS: Compared to group 2, patients who underwent surgery under conduction anesthesia reported significantly lower pain intensity during the early postoperative period at all 9 assessment points within 24 h. Peak pain intensity occurred 18 h postoperatively in both groups, but was significantly lower in group 1 (1.6±2.13) than in group 2 (5.6±2.13, p=0.00). At 24 h, pain levels remained lower in group 1 (the difference was not statistically significant, p=0.063). The need for systemic analgesics during the first 21 postoperative hours in all groups was also significantly lower (p <0.05).

CONCLUSION: Ultrasound-guided conduction anesthesia is the method of choice for surgical treatment of mine-explosion and gunshot shrapnel injuries of the limbs at the qualified care stage in medical practice.