Peripheral Nerve Blocks in Non-Operative Settings: A Review of the Evidence and Technical Commentary

Abstract

This narrative review summarizes and comments the evidence derived from randomized controlled trials pertaining to the efficacy of peripheral nerve blocks in non-operative settings. The literature search was conducted using the Medline (1966-present), Embase (1980-present), Web of Science (1900-present) and Sciverse Scopus (1996-present) databases. The following search terms were used: (“peripheral nerve block” OR “brachial plexus block” OR “interscalene block” OR “supraclavicular block” OR “infraclavicular block” OR “axillary block” OR “humeral canal block” OR “lumbosacral plexus block” OR “lumbar plexus block” OR “femoral nerve block” OR “lateral femoral cutaneous block” OR “obturator nerve block” OR “sciatic nerve block”) AND (“fractures” OR “Emergency Room” OR “Emergency Department” OR “ambulance” OR “prehospital” OR “Intensive Care Unit” OR “Intensive Care”). Only randomized controlled trials were retained for analysis. Despite methodological shortcomings, the available evidence suggests that peripheral nerve blocks can provide pain control for upper and lower limb trauma in non-operative settings. For instance, brachial plexus blocks offer a useful alternative to procedural sedation for fracture manipulation in the Emergency Department. Lumbar plexus, 3-in-1 and femoral blocks can provide analgesia for patients with hip fractures. Femoral blocks also result in more comfortable ambulance transfers to the hospital for patients suffering from hip and knee trauma. Finally, in very elderly subjects, fascia iliaca blocks can decrease the incidence and duration of perioperative delirium. Published reports of randomized trials provide evidence to formulate limited recommendations regarding the use of peripheral nerve blocks in non-operative settings. Further well-designed studies are warranted.