Continuous peripheral nerve blocks for analgesia of ventilated critically ill patients with multiple trauma: a prospective randomized study

Background: Sedation of ventilated critically ill trauma patients requires high doses of opioids and hypnotics. We aimed to compare the consumption of opioids and hypnotics, and patient outcomes using sedation with or without continuous regional analgesia (CRA).Methods: Multiple trauma-ventilated patients were included. The patients were randomized to receive an intravenous analgesia (control group) or an addition of CRA within 24h of admission. A traumatic brain injury (TBI) patients group was analyzed. The primary endpoint was the cumulative consumption of sufentanil at 2 days of admission. Secondary endpoints were cumulative and daily consumption of sufentanil and midazolam, duration of mechanical ventilation, intensive care unit (ICU) stay, and safety of CRA management.Results: Seventy six patients were analyzed: 40 (67.5% males) in the control group and 36 (72% males) in the CRA group, respectively. The median [IQR] Injury Severity Score was 30.5 [23.5-38.5] and 26.0 [22.0- 41.0]. The consumption of sufentanil at 48h was 725 [465-960] mu g/48h versus 670 [510-940] mu g/48h (p = 0.16). Daily consumption did not differ between the groups except on day 1 when consumption of sufentanil was 360 [270-480] mu g vs. 480 [352-535] mu g (p = 0.03). Consumptions of midazolam did not differ between the groups. No difference was noted between the groups according to the secondary endpoints.Conclusions: CRA does not decrease significantly sufentanil and midazolam consumption within the first 5 days after ICU admission in multiple trauma-ventilated patients. The use of peripheral nerve blocks in heavily sedated and ventilated trauma patients in the ICU seems safe.(c) 2022 Published by Elsevier Masson SAS on behalf of Socie acute accent te acute accent franc , aise d'anesthe acute accent sie et de re acute accent animation (Sfar).

Automated summary

This study aimed to compare the consumption of opioids and hypnotics and patient outcomes in multiple trauma-ventilated patients with or without continuous regional analgesia (CRA). The results showed that the use of CRA did not significantly decrease the consumption of sufentanil and midazolam in the first 5 days after ICU admission. There were no significant differences in the primary and secondary endpoints between the groups.