Army Physicians Working Toward Bringing Wounded Troops Home Pain-Free

Army 1st Lt. Melissa J. Stockwell is all smiles as she poses with her husband, Army 1st Lt. Richard Stockwell, at Washington's Walter Reed Army Medical Center. She was given regional anesthesia nerve blocks to lessen the pain of losing her left leg in Iraq. Both Stockwells said she suffered excruciating pain during two medical evacuation flights. "If she could have had this on the plane, it would have been a lot better (pain-wise)," he said. Photo by Rudi Williams   (Click photo for screen-resolution image);high-resolution image available.

Arriving in Iraq on March 9, Stockwell, then a platoon leader with the 1st Cavalry Division, 27th Main Support Battalion, was driving along in a Humvee without doors attached when an improvised explosive device exploded. The impact slammed the vehicle against a guardrail, crushing the young lieutenant's left leg.

"They amputated below the knee that same day, and amputated above the knee here on April 23," Stockwell said from her bed at Washington's Walter Reed Army Medical Center. "The initial amputation was in the 'Green Zone' in Baghdad." The zone is the blocked off, heavily secured area in central Baghdad that houses the Coalition Provisional Authority and other offices.

Stockwell was racked with pain during medical evacuation flights from Iraq for treatment at Landstuhl Regional Medical Center in Germany, and from there to Andrews Air Force Base, Md., en route to Walter Reed. Medical personnel tried to ease her pain with morphine and other pain management drugs, but the drugs didn't erase all of it.

She arrived at Walter Reed on the night of April 19, and doctors performed a regional anesthesia block the next morning to better manage her pain. Regional anesthesia allows doctors to block signals to the brain from the wound region.

The technique was a godsend for Stockwell. She said the procedure -- a continuous peripheral nerve block in medical parlance -- has greatly reduced her pain. "It would be horrible without it," she said. "It has helped me so much!"

Stockwell explained that her pain had gone from a 9 down to 2 daily. The numbers represent a gauge for people pain with pain the lower the number, the less pain the person experiences.

"It has been great since I got the anesthesia. All of these blocks have been incredible -- absolutely incredible," she declared.

Stockwell said her husband, Army 1st Lt. Richard C. Stockwell, remembers more than she does about what happened during the first couple of days after her injury. "It would have helped on the way back if she had had the regional anesthesia," said her husband, who also was serving with the 1st Cavalry Division in Iraq at the time. "Regional anesthesia is the best thing they've done for her in terms of mitigating the pain. When the first surgery happened in Baghdad, they offered this as a possible method to mitigate pain. But 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."

Based on his wife's experience, Richard Stockwell said regional anesthesia should be given, not just offered, to people in similar circumstances. "The plane flights were horrible," he noted. "If she could have had this on the plane, it would have been a lot better."

The Army's regional anesthesia pain management initiative started in 2000 as 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.

"We were looking for ways we could improve battlefield pain control," Buckenmaier explained. "We were also trying to find an anesthetic that reduces our logistics footprint. Regional anesthesia has a lot of qualities that make it an ideal battlefield anesthetic. It doesn't require a lot of equipment, and it allows patients to maintain their sensorium. We don't need a lot of machines to provide an anesthetic. It provides excellent conditions for a surgeon to do his job.

"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."

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."

Noting that service members are very concerned about pain control, Buckenmaier said, "We have examples upstairs (at Walter Reed) where we can show the difference we've made in wounded soldiers' lives with these techniques."