Analgesic effect of single-acupuncture lumbosacral plexus block in simulated field emergency care for trauma patients with lower limb injuries
Objective To evaluate the analgesic effect of single-acupuncture lumbosacral plexus block during the 120-ambulance first aid on site for trauma patients with lower limb injuries,and to evaluate the feasibility and effectiveness in simulated battlefield.Methods From Jun.2023 to Nov.2023,the 120-ambulance center of No.960 Hospital of PLA Joint Logistics Support Force managed 50 cases of lower limb injuries on site,including 29 males and 21 females aged 20-60(mean 45.7)years.The average body mass index wasZ(23.54±2.86)kg/m2;the American Society of Anesthesiologists classification showed 36 cases of grade Ⅰ and 14 of grade Ⅱ.One anes-thetist was enrolled in the rescue team to stimulate battlefield emergency rescue and conduct all the analgesic treat-ments.Patients were divided into control group or observation group according to the random number table method,with 25 cases in each group.After arriving at the trauma scene,patients in the observation group received ultra-sound-guided(handheld)single-acupuncture lumbar plexus block with 0.25%ropivacaine,while those in the control group were intramuscularly injected with 10 mg morphine hydrochloride.The analgesic effect assessed by the numer-ical rating scale(NRS)and hemodynamic status were monitored at 5 time points:immediately after analgesia(T0),5 min during pre-hospital transportation(T1),15 min during pre-hospital transportation(T2),on admission(T3),and entrance of the operating room(T4).The operation time and onset time for analgesic treatment,adverse reac-tions,and satisfaction scores from patients were compared between the two groups,as well as the post-traumatic stress disorder scale-5th edition(PCL-5)scores at 7 d and 3 months after injury and the incidence of chronic pain.Results At T1,T2,T3,T4,the NRS at resting state was much lower in the observation group than in the control group(4.1±1.3 vs.6.3±1.2,2.7±1.2 vs.5.0±0.9,1.7±0.9 vs.3.8±1.0,1.2±0.7 vs.2.9±0.8,all P<0.05),moreover,the NRS at movement status was also much lower in the observation group(5.4±1.6 vs.7.8±1.2,3.9±1.4 vs.6.5±1.0,2.8±1.1 vs.5.4±1.1,2.2±1.0 vs.4.6±1.0,all P<0.05).At T1,T2,T3 and T4,the MAP(mmHg)was significantly more stable in the observation group(99.4±7.6,95.4±6.1,94.2±6.2,94.6±5.4)than that in the control group(106.4±8.2,90.2±7.6,88.3±7.6,88.4±7.8)(all P<0.05),while the heart rate and SpO2 showed no significant difference between the two groups(all P>0.05).The observation group re-vealed longer operation time for analgesia(min,6.1±0.8 vs.1.7±0.7)but much quicker relief of pain(min,5.9±1.0 vs.10.5±1.4)(both P<0.05).Much more patients in the observation group were satisfied with the analgesia effect(P<0.05).The incidence of adverse reactions(4%vs.52%),the proportion of patients with supplementary analgesia(24.0%vs.68.0%)and doses[mg,0(0,2.5)vs.5(0,10)]were much lower in the observation group(both P<0.05).The PCL-5 scores were also much lower in the observation group at 7 d(12.10±3.58 vs.28.20±8.07)and 3 months(8.16±2.78 vs.16.28±6.26),with less incidence of chronic pain(16.0%vs.44.0%,P<0.05).Conclusion Single acupuncture lumbosacral plexus block can rapidly,safely and effectively relieve the pain of trauma patients with lower limb injuries,with reduced side effects caused by the use of systemic analgesics,PTSD and chronic pain,and increased satisfaction.It is worthy of promotion and application in the early treatment of combat injuries.
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