{
  "abstract": "Background and Aims High-energy polytrauma patients with rib fractures, pleural effusion, and multiple orthopedic injuries face dual challenges: respiratory compromise risks from general anesthesia and thromboembolic complications from prolonged immobilization. This case underscores the role and safety of regional anesthesia in solving perioperative challenges between the surgical urgency and duration versus patients acute conditions.Methods A 55-year-old male, victim of a high-kinetic vehicle accident, presented with acetabular/forearm/9th rib fractures, pleural effusion, right lower lobe atelectasis, and perirenal hematoma. Ultrasound-guided regional anesthesia included a fascia iliaca, obturator, and subgluteal sciatic blocks for acetabular fixation combined with subdural anesthesia and an axillary block for forearm fracture repair. Light propofol sedation maintained spontaneous ventilation during 6-hour surgery.Results Hemodynamic stability was achieved without vasopressors and mechanical ventilation was avoided, a critical problem given the thoracic injuries. Regional techniques provided optimal postoperative analgesia, enabling ambulation by day 4 and discharge on day 6 – key factors in reducing immobilization-related complications. The case illustrates two evidence-based advantages: mechanical ventilation avoidance preserving respiratory function in pleural effusion/atelectasis and early surgery timing minimizing thromboembolic risks without exacerbating hematoma expansion.Conclusions Comprehensive regional anesthesia enables complex polytrauma management in non-intensive care settings, resolving critical challenges between surgical timing, bleeding risks, and thrombosis prevention. This approach proved to be safe and effective in resource-limited environments while providing an enhanced recovery.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology Department, ULS Santa Maria, Lisbon, Portugal"
      ],
      "name": "Rui Macedo-Campos"
    },
    {
      "affiliations": [
        "Anesthesiology Department, ULS Barcelos e Esposende, Barcelos, Portugal"
      ],
      "name": "João Paulo Aguiar"
    },
    {
      "affiliations": [
        "Anesthesiology Department, ULS Barcelos e Esposende, Barcelos, Portugal"
      ],
      "name": "Joana Correia"
    }
  ],
  "title": "P168 Regional anesthesia for a polytrauma patient in a non-intensive care setting",
  "uid": "f835332e-1a17-5a2d-9374-09ce418293d6"
}