Doctor Recalls First Battlefield Use of Regional Anesthesia in Iraq

Doctors at Walter Reed Army Hospital here have been using regional anesthesia for years, but Oct. 7, 2003, was the first time they used it on the battlefield.

Regional anesthesia involves placement of a catheter through which local anesthetic can be administered to a specific area where the patient is experiencing pain.

"Army Spc. Brian Wilhelm was the first individual that ever had a continuous peripheral nerve block on the battlefield that was used during evacuation," said Army Lt. Col. (Dr.) Chester C. Buckenmaier III, chief of the regional anesthesia section at Walter Reed. "We kept him pain-free from Iraq to Landsthul and from Germany back to Walter Reed by redosing him through those same catheters we inserted in Balad, Iraq. We also used the same catheters during five operations.

Wilhelm was suffering from a rocket-propelled grenade wound to the back of his leg that blew off the hamstrings.

"Specialist Wilhelm was awake during the operation, just slightly sedated," the pioneering anesthesiologist said. "He was wide awake at the end of the case, interacting with his buddies. It was a happy time, rather than a sorrowful time like it usually is after a general anesthetic, where patients are groggy and feel so bad about what's happened to them, and you can't really talk to them.

"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. Brian went through a horrible experience. And, yes, it was a horrible wound. Brian went on to lose his leg, but he's pain-free!"

Buckenmaier was on a forward surgical team with the 31st Combat Support Hospital in Balad. He said the first definitive surgery wounded soldiers get is at a combat support hospital, and that's where anesthesiologist work and where regional anesthesia techniques are used.

"I'm unaware of it being used in Afghanistan, but I do know that it's being used at the 31st Support Hospital in Baghdad and in Balad," he noted. Army Col. (Dr.) Jack Childs, the consultant to the Army surgeon general for anesthesia, is in Baghdad, he added, and Maj. (Dr.) Todd Williams is in Balad.

Buckenmaier said the Army surgeon general was concerned about wounded soldiers being flown from the battlefield in excruciating pain. The surgeon general sent an e-mail to Childs, who was Buckenmaier's boss at the time, asking if anything could be done to mitigate pain in wounded soldiers being medically evacuated from Iraq.

"Well, here at Walter Reed, we'd been working with regional anesthesia for a long time," Buckenmaier pointed out. "We'd been preaching that we could do this for years. So finally, the surgeon general said 'put your money where your mouth is. Why don't you go and prove it?'"

Buckenmaier went to Iraq hoping to get a case or two, but it turned out to be much more than he expected. "I wanted that index case, which Brian Wilhelm was, to prove that we could do this," Buckenmaier said. "But it exploded. It's such a good idea that the surgeons ceased allowing us to just put it in Americans. They immediately (realized) 'I don't have to take this Iraqi prisoner back to the operating room to do a dressing change every time. I can have this doctor put this block in, and he can dose the catheter and do the dressing change right at the bedside.'

"That's where this is really impacting in Iraq," he continued. "Most of the American soldiers get injured and they're out of the country within 48 hours. Some of them are moving so fast that we don't have time to get a block in them. But when the Iraqis get injured, they don't go anywhere. So these catheters are being used every day in Iraqis."