Pain Following Battlefield Injury and Evacuation: A Survey of 110 Casualties from the Wars in Iraq and Afghanistan

• Published in: Pain medicine (Malden, Mass.) Mass.), 2009-11, Vol.10 (8), p.1487-1496
• Main Authors: Buckenmaier III, Chester C., Rupprecht, Christine, McKnight, Geselle, McMillan, Brian, White, Ronald L., Gallagher, Rollin M., Polomano, Rosemary
• Format: Article
• Language: English
• Subjects: Adult; Afghan Campaign 2001; Analgesia - standards; Analgesia - statistics & numerical data; Analgesia - trends; Anxiety - epidemiology; Anxiety - prevention & control; Combat Casualty Care; Comorbidity; Continuous Peripheral Nerve Block; Data Collection; Depression - epidemiology; Depression - prevention & control; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; Hospitals, Military - standards; Hospitals, Military - statistics & numerical data; Humans; Iraq War, 2003-2011; Male; Military Medicine - standards; Military Medicine - statistics & numerical data; Nerve Block - methods; Nerve Block - standards; Nerve Block - statistics & numerical data; Neuropsychological Tests; Pain; Pain - epidemiology; Pain - psychology; Pain Management; Pain Measurement - methods; Pain Outcomes; Quality of Health Care - standards; Quality of Health Care - statistics & numerical data; Transportation of Patients - standards; Transportation of Patients - statistics & numerical data; Warfare; Wounds and Injuries - epidemiology; Wounds and Injuries - nursing; Wounds and Injuries - psychology; Young Adult
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2009.00731.x

ABSTRACT Objective.  Advances in regional anesthesia, specifically continuous peripheral nerve blocks (CPNBs), have greatly improved pain outcomes for wounded soldiers in Iraq and Afghanistan. Pain management practice variations, however, do exist, depending on the availability of pain‐trained military professionals deployed to combat support hospitals. An exploratory study was undertaken to examine pain and other outcomes during evacuation and at Landstuhl Regional Medical Center (LRMC), Germany. Design.  A mixed‐methods, semistructured interview survey design was conducted on a convenience sample of wounded U.S. soldiers evacuated from Iraq and Afghanistan to LRMC. Setting and Patients.  A total of 110 wounded soldiers evacuated from Iraq and Afghanistan from July 2007 to February 2008 completed a pain survey at LRMC. Data were collected on demographics, injury mechanism, last 24‐hour average, least, and worst, and pain now by using a 0–10 scale, and percent pain relief (from 0% [No relief] to 100% [Complete relief]). Similar items and measures of anxiety, distress, and worry during flight transport were measured (from 0 [None] to 10 [Extreme]). Responses were analyzed by using descriptive and correlational statistics, multiple linear regression, Mann–Whitney U‐tests, and t‐tests. The Walter Reed Army Medical Center, Human Use Committee approved this investigation. Results.  Participants were typically male (99.1%), Caucasian (80%), and injured from improvised explosive devices (60%) and gunshots (21.8%). Average and worst pain scores were inversely correlated with pain relief during transport (r = −0.58 and r = −0.46, respectively; P