**Thanks**

Recent advances in point-of-care coagulation testing like thromboelastography provide rapid, objective assessment of hemostatic function. This may be used before interventions, to detect

Chronic pain is more common following trauma than often realized, inadequate management of acute pain increases the risk of development of chronic pain syndrome. It may be due to nociceptive pain or often include a neuropathic component, which can be difficult to treat. There are several pain syndromes such as complex regional pain syndrome (CRPS), postamputation pain, and posttraumatic stress disorder which are specifically associated with

Early, effective and sustained analgesia and usage of peripheral nerve blocks after injury decreases the incidence and severity of chronic pain syndromes. Administration of low and therapeutic doses of antidepressants, oral ketamine and gabapentin should be considered for

Trauma represents a considerable and increasing demand on healthcare resources. Early resuscitation and on-arrival block forms primary goal initial management of polytrauma patients. Advances in regional anesthesia, better training and availability of point of care sonography allowed safer administration of RA and peripheral nerve block in critically ill polytrauma patients. Early administration of peripheral nerve blocks minimizes pulmonary and cardiovascular complications, decreases incidence of posttraumatic stress disorder and chronic pain syndrome, allows prompt mobilization and significantly reduces consumption of narcotic analgesics. Careful use of regional anesthetics in polytrauma patients, reduce duration of hospital stay and delirium in elderly patients. Regional anesthesia and peripheral nerve blocks are not devoid of adverse effects like systemic LA toxicity, neurovascular injury, and compartment syndrome. Selecting proper regional anesthesia technique, usage of appropriate local anesthetic concentration and volume, these complications can be reduced. RA is more versatile and reliable than ever before, with appropriate patient selection and usage of ultrasonography, such interventions are effective and safe. When used carefully in selected polytrauma patients regional anesthesia provides a cost-effective and safer method of analgesia in injured patients in both during surgery and perioperative

type of coagulopathy and to administer specific coagulation factors.

**6.4. Chronic pain**

98 Anesthesia Topics for Plastic and Reconstructive Surgery

persistent pain [16, 17].

**7. Conclusion**

settings.

Nil.

**Conflict of interest**

trauma.

I would like to thank my wife Dr. Shruthi for her support in preparing this chapter.
