Compartment Syndrome and Regional

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How long do you wait after an extremity fracture before you are willing to do a peripheral nerve block. I remember from residency waiting 7 days after fresh fractures to reduce the chance of compartment syndrome occuring. Just wondering how long everyone else waits.

http://bja.oxfordjournals.org/content/102/1/3.abstract

http://onlinelibrary.wiley.com/doi/1...109.x/abstract


http://www.em-consulte.com/en/article/220009

Originally Posted by secoy

How long do you wait after an extremity fracture before you are willing to do a peripheral nerve block. I remember from residency waiting 7 days after fresh fractures to reduce the chance of compartment syndrome occuring. Just wondering how long everyone else waits.

depends on the fracture. Usually have a discussion with the orthopod and ask if they are concerned about it in this patient and if I should avoid a block.

Originally Posted by secoy

How long do you wait after an extremity fracture before you are willing to do a peripheral nerve block. I remember from residency waiting 7 days after fresh fractures to reduce the chance of compartment syndrome occuring. Just wondering how long everyone else waits.

It doesn't enter into my decision. I've asked this question of many of the experts in regional and have largely adopted my position based on their views. At the same time I don't block patients if the orthopedist is set against it--but they get to manage the patient's pain in that case.

Curious to hear what others do?

im convinced its a myth, but the reasoning that a patient may not report pain as early as they would without a block seems sound. ultimately i dont care unless its someone i dont want to put to sleep, usually for a lower extremity injury.

I don't do blocks on long bone fractures except occasionally on femoral shaft fractures.