French clinical guidelines for peripheral motor nerve blocks in a PRM setting

Area of Science:

• Anesthesiology
• Physical and Rehabilitation Medicine

Background:

• Motor nerve blocks using anesthetic drugs are prevalent in Physical and Rehabilitation Medicine (PRM), particularly for managing spasticity.
• Current guidelines for these procedures in PRM are notably absent.

Purpose of the Study:

• To establish expert-driven guidelines for the safe and effective use of loco-regional anesthetic drugs for motor nerve blocks within the PRM setting.
• To address key aspects including indications, drug selection, contraindications, adverse event management, and procedural techniques.

Main Methods:

• A panel of 18 experts from French PRM and Anesthesia societies developed the guidelines.
• Literature review of Medline, Cochrane, and Embase (1999-2018) was conducted, analyzing 355 papers.
• Guidelines were drafted, commented on, and approved by the expert panel via electronic vote.

Main Results:

• The literature review yielded no scientific evidence, making the guidelines primarily based on expert opinion.
• Specific dosage recommendations were established: lidocaine up to 2mg/kg and ropivacaine up to 1.5mg/kg (max 100mg).
• Conditions for administering these doses, including contraindication checks and availability of emergency support, were defined, with higher doses requiring an anesthesiologist.

Conclusions:

• These represent the first organizational guidelines specifically for motor nerve blocks in PRM.
• The guidelines aim to enhance the safety and standardization of motor nerve block procedures in physical and rehabilitation medicine.