Articles: nerve-block.
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Anesthesia and analgesia · May 2023
Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome.
In this Pro-Con commentary article, we discuss the controversial debate of whether to provide peripheral nerve blockade (PNB) to patients at risk of acute extremity compartment syndrome (ACS). Traditionally, most practitioners adopt the conservative approach and withhold regional anesthetics for fear of masking an ACS (Con). Recent case reports and new scientific theory, however, demonstrate that modified PNB can be safe and advantageous in these patients (Pro). This article elucidates the arguments based on a better understanding of relevant pathophysiology, neural pathways, personnel and institutional limitations, and PNB adaptations in these patients.
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The role of neuromodulation in fascial plane blocks is unknown. This case report presents a complex patient who underwent shoulder arthroplasty with a high thoracic-erector spinae plane (HT-ESP) catheter that provided electrical and chemical neuromodulation, highlighting the potential of electrical stimulation in the identification of and therapy at the fascial plane level.
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The erector spinae plane block (ESPB) is a less invasive, safer, and technically easier procedure compared to the conventional neuraxial technique. Although the ESPB is a favored and easy technique compared to neuraxial block, there is no study with a large number of patients describing the exact spread level of injected local anesthetics. ⋯ The ESPB 20 mL group showed a more extensive distribution of contrast medium than that of the ESPB 10 mL group. Inadvertent injections into the epidural space, psoas muscle, and intravascular system were observed. Among them, intravascular system injections were found to be the most common (12.9%).