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Abstract
Introduction Traditionally, using peripheral nerve blocks (PNBs) in patients with long bone fractures has been limited due to concerns that it may interfere with the timely diagnosis of acute compartment syndrome (ACS). However, our large academic institution and level I trauma center have been using regional anesthesia routinely for pain management of patients with long bone fractures for more than a decade, with strict adherence to a comprehensive management protocol. The aim of this retrospective review is to present our experience with this practice.
Methods Following Institutional Review Board approval, we performed a retrospective chart review of patients with long bone fractures and ACS over a 10-year period (2008–2018).
Results 26 537 patients were included in the review. Approximately 20% of these patients required surgery, and 91.5% of surgically treated patients received regional anesthesia. The incidence of ACS in our cohort was 0.1% or 1.017 per 1000 patients with long bone fractures.
Conclusion Current recommendations on using PNBs in patients at risk for ACS have been mainly based on expert opinion and dated case reports. Due to the nature of the condition, prospective data are lacking. Our large observational dataset evaluated the risk of missing or delaying ACS diagnosis when PNBs were offered for trauma patients and demonstrated a relatively low incidence of ACS despite the routine use of PNBs under strictly protocolized conditions when patients were managed by a dedicated multidisciplinary care team.
- lower extremity
- upper extremity
- acute pain
- nerve block
- pain, postoperative
Data availability statement
Data are available on reasonable request. Not Applicable.
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Data availability statement
Data are available on reasonable request. Not Applicable.
Footnotes
Contributors SC conceived the study, collected and reviewed data, prepared and coordinated manuscript writing and editing, and serves as a study guarantor. TRP assisted with study design, IRB approval, data collection, and statistical analysis of data, and contributed to the writing and editing of the manuscript. CS assisted with study design refinement and statistical analysis and contributed to the writing and editing of the manuscript. AG assisted as a study coordinator with IRB approval, communication with the IRB throughout the study, and data collection. YZ contributed to the writing and editing of the manuscript. BI contributed to the writing and editing of the manuscript. LL-W contributed to the writing and editing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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