Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome

Abstract

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.

Risks and Benefits in Trauma Anesthesiology

“…The Pro-Con article in this trauma-themed issue of Anesthesia & Analgesia addresses an important point of controversy in modern practice: whether the known benefits of regional analgesia for postoperative pain management can be safely extended to trauma patients at risk for development of compartment syndrome in an injured extremity. 1 The authors have thoroughly reviewed the existing literature and presented the arguments for and against the use of peripheral nerve blocks. Along the way, they present suggestions for what best practice should look like—understanding that the pragmatic answer to a clinical question like this one is never black and white, but instead always some variety of “it depends.”…”