EP136 Caudal anesthesia for pelvic fractures due to combat-related blast injuries

<h3>Background and Aims</h3> Pelvic fractures resulting from combat-related blast injuries are often associated with severe pain, complex trauma, and potential complications such as haemorrhage and nerve damage. Effective pain management is crucial for patient stabilisation, early mobilisation, and preventing chronic pain development. Goal. To optimise postoperative pain management in military personnel with blast-induced pelvic fractures through the use of caudal anaesthesia, and evaluate outcomes including pain relief, side effects, and patient satisfaction. <h3>Methods</h3> <h3>Materials and Methods</h3> The study included two randomised groups, each consisting of 12 military patients undergoing treatment for pelvic fractures of blast injury origin. The experimental group received a single-dose CA composed of 30 ml of 0.125% bupivacaine combined with 0.12 mg of buprenorphine, administered 30 minutes before surgical intervention. The control group was on mechanical ventilatory support (ventilation) and received standard analgesic therapy with intravenous fentanyl at a dose of 1.5–2 μg/kg/hr and 10 mg of diazepam for pain management. Additionally, propofol was administered for sedation during the surgical procedure. <h3>Results</h3> The CA group exhibited significantly reduced pain levels, with a Visual Analogue Scale (VAS) score nearing zero within the first 48 hours postoperatively, in contrast to the control group, which exhibited higher pain levels despite sedation. The CA group’s absence of nausea and pruritus indicated a lack of notable side effects associated with regional anaesthesia. Patient satisfaction, measured using the Hospital Anxiety and Depression Scale (HADS), was substantially higher in the CA group, reflecting not only effective pain control but also overall comfort and well-being. <h3>Conclusions</h3> Caudal anaesthesia using a combination of bupivacaine and buprenorphine is an effective, safe, and well-tolerated method for perioperative pain management in military personnel with combat-related blast-induced pelvic fractures. It significantly improves pain relief, reduces reliance on systemic opioids, and enhances patient satisfaction, with minimal adverse effects.