Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome

Samet, Ron E.; Torrie, Arissa M.; Chembrovich, Svetlana; Ihnatsenka, Barys

doi:10.1213/ane.0000000000006394

Cited by 6 publications

(4 citation statements)

References 46 publications

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“…In the recent Pro-Con debate about the use of PNB for trauma patients, authors highlighted the fact that a developing ACS with breakthrough pain might be more easily detected [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

Hilber,

Dodi,

Blumenthal

et al. 2024

JCM

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Regional anesthesia has shown to be successful in controlling major pain in trauma patients. However, the possibility of masking acute compartment syndrome (ACS) after peripheral nerve blocks for limb injuries is still controversially discussed. Therefore, we aimed to summarize the current literature regarding this topic to shed light on the impact of peripheral regional anesthesia on the diagnosis of ACS in trauma patients. We searched Pubmed, Google Scholar and the Cochrane Library for literature following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The analysis of these reports was included in the context of the current literature concerning this topic. We found no (randomized) studies, and only six case reports dealing with the impact of peripheral nerve blocks and ACS in patients after a limb trauma met our criteria and were included in our review. Only one reported a delay in the diagnosis of ACS. In most of the cases (5 of 6), the breakthrough pain, despite the nerve block, proved to be a good indicator of a developing ACS. However, despite some narrative articles about the topic including some recommendations about the possibly safe use of regional anesthesia techniques for limb trauma, there is still no international consensus and only one national guideline focusing on the possibly safe use of peripheral nerve blocks in trauma patients at risk of ACS. After reviewing the respective literature, we consider that intra-articular analgesia, sensory blocks, fascial plane blocks and low-concentration continuous peripheral nerve blocks are effective for analgesia and a low-risk analgesia tool for trauma and postsurgical patients at risk of ACS due to the fact that they do not lead to a dense block. Finally, we summarized suggestions based on the results of the literature for the different regional anesthesia modalities in these patients in a table to facilitate the use of these techniques.

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“…In the recent Pro-Con debate about the use of PNB for trauma patients, authors highlighted the fact that a developing ACS with breakthrough pain might be more easily detected [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

Hilber,

Dodi,

Blumenthal

et al. 2024

JCM

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“…Existing literature on compartment syndrome lacks prospective, randomized controlled study results and lacks information-rich meta-analyses. Therefore, for trauma patients, rather than debating whether to perform peripheral nerve blocks for limb pain management, it is more important to focus on closely monitoring the use of analgesics, the occurrence of breakthrough pain, and monitoring compartment pressures in high-risk patients [71]. Vigilance on the part of surgical, anesthesia, and nursing teams involved in trauma patient care at all trauma centers is crucial for the early detection of compartment syndrome [72].…”

Section: Masking Patient Conditionsmentioning

confidence: 99%

“…However, before the onset of typical seizures and circulatory arrest, patients often experience prodromal symptoms, such as perioral numbness and metallic taste. Hence, vigilant monitoring and early recognition of these prodromal symptoms are essential to prevent serious consequences associated with local anesthetic toxicity reactions [71]. In the context of trauma centers providing early analgesic treatment to trauma patients using ultrasound-guided peripheral nerve blocks, it is crucial to acknowledge that some centers may lack the necessary monitoring equipment and adequate healthcare staff for close patient surveillance.…”

Section: Local Anesthetic Toxicity Reactionsmentioning

confidence: 99%

Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers

Huaguo,

Kang,

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Trauma, particularly extremity trauma, poses a considerable challenge in healthcare, especially among young adults. Given the severity of patient pain and the risks associated with excessive opioid use, managing acute pain in trauma centers is inherently complex. This study aims to investigate the application and benefits of ultrasound-guided nerve blocks for early pain management in patients with extremity trauma positioned supine. Methods A comprehensive literature review was conducted to assess the effectiveness and advantages of ultrasound-guided peripheral nerve blocks in the acute pain management of extremity trauma patients in the supine position. Special emphasis was placed on evaluating the selection criteria, indications, contraindications, adverse reactions, and potential complications associated with these nerve block techniques. Results Ultrasound-guided nerve blocks represent a safer and more precise option for managing pain in extremity trauma patients placed in the supine position. These techniques offer significant advantages in terms of reducing healthcare expenses, diminishing reliance on opioid medications, and mitigating opioid-related complications. Nonetheless, challenges may arise due to the necessity for patient cooperation during specific nerve block procedures. Conclusion Ultrasound-guided nerve blocks present a promising avenue for early pain management in extremity trauma patients positioned supinely. Their implementation can lead to improved patient outcomes by alleviating pain severity, reducing opioid consumption, and cutting down healthcare costs. Further research and clinical integration of these techniques is imperative to enhance pain management protocols in trauma centers.

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“…The Pro-Con article in this trauma-themed issue of Anesthesia & Analgesia addresses an important point of controversy in modern practice: whether the known benefits of regional analgesia for postoperative pain management can be safely extended to trauma patients at risk for development of compartment syndrome in an injured extremity. 1 The authors have thoroughly reviewed the existing literature and presented the arguments for and against the use of peripheral nerve blocks. Along the way, they present suggestions for what best practice should look like—understanding that the pragmatic answer to a clinical question like this one is never black and white, but instead always some variety of “it depends.”…”

mentioning

confidence: 99%

Risks and Benefits in Trauma Anesthesiology

Dutton

Pivalizza

Choi

2023

Anesthesia &Amp; Analgesia

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Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome

Cited by 6 publications

References 46 publications

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers

Risks and Benefits in Trauma Anesthesiology

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