General considerations Peripheral nerve blocks are frequently utilized for elective surgical procedures in ambulatory or inpatient settings. While the benefits of nerve block anesthesia are well described in the anesthesia and orthopedic literature, fewer investigations describe the performance of peripheral nerve blockade in the trauma population. However, based upon the experience of the United States Armed Forces, and on recent reports of the successful use of nerve blocks in major earthquake victims, it appears that regional anesthesia techniques can not only be successfully utilized in trauma, but may be the preferred anesthetic choice in austere environments. Regional anesthesia: concerns in the trauma patient Obtaining informed consent Due to the nature of the physician-trauma patient encounter, obtaining informed consent may be challenging. Since peripheral nerve blocks offer substantial benefits for the patient and may even result in better surgical outcomes (e.g., continuous sympathetic blockade to prevent vasospasm after digital reattachment), alternative paths to obtaining consent may be indicated. If patients are not able to provide consent, one of the following options may prove feasible: • Obtain consent from proxy or family member. • Consider a two-physician consent in emergency cases, should benefits of regional blockade be expected to be substantial. • Postpone peripheral nerve block procedure until consent can be obtained.
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