Selective sensory nerve blocks for effective pain management in the emergency department for a term pregnant cobra snake envenomation patient

Response to “Peripheral Nerve Block to Treat Pain Caused by Daboia palaestinae Envenomation”

“…We would like to inform the readers that the use of peripheral nerve blocks (PNBs) for the management of snake bite pain is not new and has already been reported. 2,3 So, the author’s claim for this to be a novel case description is questionable, and we would advise the authors to have a thorough literature search.…”

“…As the site of the bite is a finger, a selective PNB like superficial radial, median, and ulnar at the level of the forearm could have been administered as a safer option. [2][3][4][5] This would have facilitated the monitoring of early signs of development of the compartment syndrome, and the additional risk of side effects of SCBPB, like pneumothorax, local anesthetic systemic toxicity (LAST), prolonged motor blockade, hematoma, could have been avoided. 3,5 Of particular concern to this case is that the authors mentioned that snake venom consisted of 74% of hemorrhagins, which can lead to hemolysis, thrombocytopenia, and cardiovascular instability.…”

“…However, considering our extensive experience managing such cases, we think this patient would have benefited if ASV had been administered in time. 2,3 Several venom components are involved in the molecular mechanisms responsible for pain after envenomation. So, administering ASV has the advantage of controlling pain in addition to treating the systemic symptoms.…”