Army Regional Anesthesia and Pain Management Initiative
"We look at pain not as a symptom of a disease, but as a disease in and of itself."—Colonel Trip Buckenmaier, M.D.
Despite tremendous advances in battlefield medical treatment, pain management has changed very little since the Civil War, with morphine being the primary medication used for pain control. The Army Regional Anesthesia & Pain Management Initiative (ARAPMI) at Walter Reed Army Medical Center (WRAMC), in conjunction with the tri-service group Military Advanced Regional Anesthesia and Analgesia (MARAA), is spearheading a movement to transform the military's approach to pain.
ARAPMI staff are focused on finding and implementing the most effective methods of relieving acute pain from combat trauma. Their comprehensive approach makes use of many pain relief techniques, from traditional opioids to continuous nerve blocks and multimodal drug therapy.
Continuous Peripheral Nerve Blocks
General anesthesia suppresses the activity of the central nervous system and requires a lot of equipment and constant monitoring by a trained specialist. When the anesthesia wears off, patients often have to take large doses of narcotics, which aren't always effective, to control the pain.
With a continuous peripheral nerve block, the doctor inserts a tiny catheter next to the nerves serving the wounded area. A small infusion pump administers doses of anesthetics that block pain signals before they can be transmitted to the brain. Unlike with general anesthesia or narcotic medications, a patient can be fully awake and pain free, despite having suffered a traumatic injury.
From Recommendation to Reality
On October 7, 2003, the first continuous peripheral nerve block ever to be administered on the battlefield and used in an evacuation was performed. Since that landmark case, MARAA staff have performed the blocks on hundreds of wounded soldiers, with great success.
Program personnel are teaching the technique to resident anesthesiologists and adding it to the repertoire of trained anesthesiologists. Through USU, ARAPMI also established the first and only DoD fellowship in regional anesthesia.
Key to the success of the group's mission is keeping abreast of the latest technologies. In the last year, ARAPMI researchers have begun utilizing ultrasound technology in performing the nerve blocks. Using ultrasound, physicians can actually see the nerve response and watch the needle as they guide it into the target area. This new visual tool makes it much easier for clinicians to perform the blocks.
ARAPMI is a collaborative research partnership between WRAMC and the Conemaugh Health System, Johnstown, Pa.