Army Physicians Working Toward Bringing Wounded Troops Home Pain-Free

Military Medicine, Summer 2004

Army 1st LT Melissa J. Stockwell was a platoon leader with the 1st Calvary Division, 27th Main Support Battalion serving in Iraq in early March. She was driving a Humvee without doors when an improvised explosive device exploded. The vehicle was slammed against a guardrail, crushing Lieutenant Stockwell's left leg.

Physicians in the heavily secured Green Zone in Baghdad amputated the leg below the knee on that day, and doctors over at Walter Reed Army Medical Center in Bethesda amputated the leg above the knee in April. Stockwell experienced massive pain during her medical evacuation flights from Iraq to the US en route to Walter Reed. Medical personnel tried to mitigate her intense pain and discomfort with standard morphine and other drugs. But the treatment did little to make the Lieutenant feel any better.

When she arrived at Walter Reed on the night of April 19th, doctors went to work on performing, a regional anesthesia block to ease her discomfort. With this treatment, doctors are able to block signals to the brain from the wounded region. What medical teams call a continuous peripheral nerve block worked wonders for Stockwell, "It would be horrible without it. It has helped me so much!"

The treatment was offered to Stockwell during the first leg of her treatment in Iraq, but medical personnel there made it sound experimental to Stockwell and her husband, Army 1st LT Richard C. Stockwell. According to him, ". . . the way the anesthesiologist explained it, {we got the impression it} was experimental. He didn't explain it like it was this great, awesome thing. He said sometimes it doesn't work." But 1st LT Melissa Stockwell simply exclaimed, "All of these blocks have been incredible, absolutely incredible."

The treatment is the brainchild of Col. (Dr.) Jack Childs, the consultant to the Army surgeon general for anesthesia, and Lt. Col. (Dr.) Chester C Buckenmaier III, chief of the regional anesthesia section at Walter Reed. Childs now is performing the procedure at the 31st Combat Support Hospital in Baghdad.

"Unlike general anesthesia, which doesn't do anything for post-operative pain control, regional anesthesia, even with a single injection, lasts a very long time," the anesthesiologist continued. "Anywhere I place one of these needles, I can place what's called a paranural (next to the nerve) catheter that will allow me continuous access so we can run infusions of local anesthetic literally for days to control pain."

First used on the battlefield in Iraq in October 2003 due to a request from the Army Surgeon General to do something about the excruciating pain injured soldiers experience when flown from the battlefield, regional anesthesia allows patients to be awake and just slightly sedated during procedures. "With this anesthetic, they're alert, they're awake, and they're talking to you like I'm talking to you right now," Buckenmaier said. "The first time we used regional anesthesia on the battlefield was a very powerful moment."

Traditionally, morphine has been the battlefield pain controller, he said. "Morphine is a drug that was first systemized in 1803. Now, more than 200 years later, we're still using the same solution for battlefield pain," Buckenmaier noted. "I'm not suggesting that the job we do in medicine on the battlefield is bad. It's not. We do it better than anybody in the history of warfare. But that doesn't mean we can't do it a little bit better. That's what this whole program is about."

Read more about this at: Walter Reed Army Medical Center

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