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.
Subject(s)
Anesthesia, Conduction , Compartment Syndromes , Nerve Block , Humans , Nerve Block/adverse effects , Anesthesia, Conduction/adverse effects , Peripheral Nerves , Compartment Syndromes/diagnosis , ExtremitiesABSTRACT
PURPOSE OF REVIEW: This narrative review is an updated summary of the value of regional anesthesia and analgesia for trauma and the special considerations when optimizing pain management and utilizing regional analgesia for acute traumatic pain. RECENT FINDINGS: In the setting of the opioid epidemic, the need for multimodal analgesia in trauma is imperative. It has been proposed that inadequately treated acute pain predisposes a patient to increased risk of developing chronic pain and continued opioid use. Enhanced Regional Anesthesia techniques along with multimodal pain therapies is thought to reduce the stress response and improve patient's short- and long-term outcomes. SUMMARY: Our ability to save life and limb has improved, but our ability to manage acute traumatic pain continues to lag. Understanding trauma-specific concerns and tailoring the analgesia to a patient's specific injuries can increase a patient's immediate comfort and long-term outcome as well.
Subject(s)
Acute Pain , Analgesia , Anesthesia, Conduction , Acute Pain/drug therapy , Acute Pain/etiology , Analgesia/adverse effects , Analgesia/methods , Analgesics, Opioid/adverse effects , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Humans , Pain Management/adverse effects , Pain Management/methods , Pain, PostoperativeABSTRACT
The use of local anesthetics for improved pain management is well established. However, significant morbidity may be caused by local anesthetic systemic toxicity (LAST) from inadvertent intravascular injection or excessive dosing of local anesthetics. Despite incomplete understanding of the mechanism of action of intravenous lipid emulsions (ILE), their use has become a first-line therapy for treating LAST. We present a case report of LAST, successfully treated with ILE with a secondary effect of complete reversal of a successful peripheral nerve block as quickly as the LAST symptoms resolved.
Subject(s)
Anesthesia, Conduction , Fat Emulsions, Intravenous , Anesthesia, Local , Anesthetics, Local/adverse effects , Fat Emulsions, Intravenous/therapeutic use , Humans , Peripheral NervesABSTRACT
Over the past decade, osteochondral allograft transplantation has soared in popularity. Advances in storage techniques have demonstrated improved chondrocyte viability at longer intervals and allowed for potential of increased graft availability. Recent studies have stratified outcomes according to location and etiology of the chondral or osteochondral defect. Unipolar lesions generally have favorable outcomes with promising 10-year survival rates. Though those undergoing osteochondral allograft transplantation often require reoperation, patient satisfaction remains high.