Ultrasound-guided selective peripheral nerve block for the snakebite pain management in the emergency department: Our experience

Abstract

Envenomation from snakebites (SBs) is a significant public health hazard globally. The venomous SB is associated with moderate-to-severe pain. Weak opioids such as tramadol or acetaminophen are commonly used for pain management but often provide inadequate analgesia. We hereby report our experience of using ultrasound-guided selective superficial peroneal, sural, and saphenous nerve blocks for pain management following SBs in nine patients. The selective peripheral nerve blocks are achieved with a small amount of local anesthesia and without loss of motor functions.

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.…”

“…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.…”

“…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.…”

Ultrasound-Guided Superficial Radial Nerve Block in the Emergency Department for Pain Management following Centipede Bite

“…Earlier reports documented the safety and efficacy of ultrasound-guided selective PNBs for procedural pain relief and snake bite pain management in the ED. 7,[9][10][11] However, its use in the pain management of CBs is not documented to date. The SRN is a branch of the radial nerve along with the posterior interosseous nerve.…”

“…Prolonged analgesia for up to 18 h can be achieved with a low dose (1.5-2 mL) of long-acting local anesthetic, such as 0.75% ropivacaine. 10 Ropivacaine is preferable in ED settings because of its better safety profile and reasonably longer duration of analgesic effect. 6 The site of the block is away from the site of the bite, thus adding to the patient's cooperation.…”