It may be administered cautiously when fluid losses have been corrected by appropriate resuscitative measures. The sympathetic block from a subarachnoid or epidural anesthetic may be advantageous for the patient with a vascular repair of the leg, while a brachial plexus or stellate ganglion block may provide the same benefit to those with vascular injuries of the arm or hand. Another advantage of these techniques is that they often provide long-acting postoperative analgesia without the use of depressant medications. The intravenous regional or Bier block is a very useful technique for extremity injuries because of its ease of administration, reliability, and relative safety. It is not a satisfactory technique if ,the limb has multiple puncture wounds or jagged foreign bodies are embedded.
Postoperative analgesia is usually of only brief duration.
Table 9 lists commonly available anesthetic agents and dosage forms. The maximum recommended dosage limits shown must, be tempered by modifying factors such as patient size, condition, and site of incision. General Anesthesia Anesthetic drug requirements in the critically injured patient will usually be much less than under more normal conditions. Often intraoperative management is primarily a matter of achieving hemodynamic stability, optimizing oxygenation, and supporting ventilation. Such patients rarely have recall of intraoperative events.