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Review
The role of hyperbaric oxygen therapy in the management of perioperative peripheral nerve injury: a scoping review of the literature
  1. Connor TA Brenna1,2,
  2. Shawn Khan1,
  3. Rita Katznelson2,3,4 and
  4. Richard Brull4,5
  1. 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, Ontario, Canada
  4. 4Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
  5. 5Department of Anesthesia, Women’s College Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Connor TA Brenna, Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; connor.brenna{at}mail.utoronto.ca

Abstract

Background/importance Peripheral nerve injury is an uncommon but potentially catastrophic complication of anesthesia and surgery, for which there are limited effective treatment options. Hyperbaric oxygen therapy is a unique medical intervention which improves tissue oxygen delivery and reduces ischemia via exposure to oxygen at supra-atmospheric partial pressures. While the application of hyperbaric oxygen therapy has been evidenced for other medical conditions involving relative tissue ischemia, its role in the management of peripheral nerve injury remains unclear.

Objective This scoping review seeks to characterize rehabilitative outcomes when hyperbaric oxygen therapy is applied as an adjunct therapy in the treatment of perioperative peripheral nerve injury.

Evidence review The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for scoping reviews, using a systematic screening and extraction process. The search included articles published from database inception until June 11, 2022, which reported clinical outcomes (in both human and non-human models) of peripheral nerve injury treated with hyperbaric oxygen therapy.

Findings A total of 51 studies were included in the narrative synthesis. These consisted of animal (40) and human studies (11) treating peripheral nerve injury due to various physiological insults. Hyperbaric oxygen therapy protocols were highly heterogenous and applied at both early and late intervals relative to the time of peripheral nerve injury. Overall, hyperbaric oxygen therapy was reported as beneficial in 88% (45/51) of included studies (82% of human studies and 90% of animal studies), improving nerve regeneration and/or time to recovery with no reported major adverse events.

Conclusions Existing data suggest that hyperbaric oxygen therapy is a promising intervention in the management of perioperative peripheral nerve injury, in which tissue ischemia is the most common underlying mechanism of injury, neurological deficits are severe, and treatment options are sparse. This positive signal should be further investigated in prospective randomized clinical trials.

  • Nerve Block
  • Neurologic Manifestations
  • Complementary Therapies
  • Peripheral Nerve Injuries
  • Postoperative Complications

https://doi.org/10.1136/rapm-2022-104113

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    Footnotes

    • Twitter @CTA_Brenna

    • Contributors CB contributed to study and search algorithm design, screening and data collection, data analysis, study coordination, drafting the initial manuscript, preparing exhibits, and revising the draft manuscript. SK contributed to study and search algorithm design, screening and data collection, data analysis, drafting the initial manuscript, preparing exhibits, and revising the draft manuscript. RK contributed to study design, and revising the draft manuscript. RB contributed to study design, revising the draft manuscript, and supervision of the project. All authors serve as guarantors of the work.

    • Funding RB receives research time support from the Evelyn Bateman Recipe Endowed Chair in Ambulatory Anesthesia and Women’s Health, Women’s College Hospital, and Merit Award Program, Department of Anesthesia and Pain Medicine, Toronto, Ontario, Canada.

    • Competing interests RK is a shareholder in the Rouge Valley Hyperbaric Medical Centre, Toronto, Ontario, Canada. The authors have no further financial conflicts of interest to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.