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Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At
Ron E Samet1, Arissa M Torrie1, Svetlana V Chembrovich2
1From the Department of Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.
Anesthesia and Analgesia
|April 14, 2023
Summary
Peripheral nerve blockade (PNB) for patients at risk of acute extremity compartment syndrome (ACS) is debated. Modified PNB may be safe and beneficial, challenging traditional conservative approaches.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Trauma Care
Background:
- Acute extremity compartment syndrome (ACS) poses a significant risk.
- Traditionally, peripheral nerve blockade (PNB) has been withheld due to concerns about masking ACS.
- Recent evidence suggests modified PNB may be safe and advantageous.
Purpose of the Study:
- To critically evaluate the controversial use of PNB in patients at risk of ACS.
- To present arguments for and against PNB in this patient population.
- To explore the scientific basis and practical considerations of PNB for ACS.
Main Methods:
- Pro-Con commentary format.
- Review of recent case reports and scientific literature.
- Analysis of pathophysiology, neural pathways, and PNB adaptations.
Main Results:
- Traditional practice avoids PNB for fear of masking ACS.
- Emerging evidence supports modified PNB as potentially safe and beneficial.
- Considerations include pathophysiology, neural pathways, and institutional factors.
Conclusions:
- The decision to use PNB in ACS risk requires careful consideration of evolving evidence.
- Modified PNB techniques may offer advantages over traditional withholding of regional anesthesia.
- Further research and discussion are needed to refine PNB protocols for at-risk patients.
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