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Regional Anesthesia and Analgesia in Critically Ill Patients: A Systematic Review

Stundner, Ottokar MD; Memtsoudis, Stavros G. MD, PhD

Regional Anesthesia & Pain Medicine:
doi: 10.1097/AAP.0b013e3182625f1a
Review Article

Abstract: Regional anesthesia has become invaluable for the treatment of pain during and after a wide range of surgical procedures. However, its benefits in the nonsurgical setting have been less well studied. Regional anesthesia is an appealing modality for critically ill patients, providing focused and sustained pain control with beneficial systemic effect profiles. Indications for regional anesthesia in this patient group are not limited to surgical and postsurgical analgesia but expand to the management of trauma-related issues, medical conditions, and painful procedures at the bedside. Patients in the critical care unit present special challenges to the regional anesthesiologist, including coagulopathies, infections, immunocompromised states, sedation- and ventilation-associated problems, and factors potentially increasing the risk for systemic toxicity. This review is intended to evaluate the role of regional anesthesia in critically ill patients, to discuss potential benefits, and to provide a summary of the published evidence on the subject.

Author Information

From the Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, NY.

Accepted for publication May 30, 2012.

Address correspondence to: Stavros G. Memtsoudis, MD, PhD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail:

This work is attributed to the Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY.

This study was performed with funds from the Hospital for Special Surgery, Department of Anesthesiology.

This manuscript has not been presented at meetings or submitted for publication, nor has it been published in whole or in part elsewhere.

The authors declare no conflict of interest.

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©2012 American Society of Regional Anesthesia and Pain Medicine