Nerve Blocks for Severe Burns: OK or not?

[ohiovolffemtp]

Has anyone here heard that nerve blocks are contra-indicated for pain control of severe burns?  I'm asking because the burn referral center to whom I transferred a patient complained to my medical director that the nerve blocks I did "was not the standard of care".  It was an intoxicated young man who fell, putting his hand into a bonfire.  He had severe deep partial thickness burns that were circumferential on multiple fingers.  Right when he came in I gave him radial, median, and ulnar nerve blocks as well as IV opiates once we had access.  His pain was hard to control.  My medical director is very supportive and the literature search I did didn't find any contra-indications.  I've not seen the burn center's reasoning, but I can't think of a contra-indication.  None of the injections were through burned areas.

Any thoughts?

[kidpresentable]

Did they specify the problem the blocks caused? Were they mad they couldn’t assess sensation in the rest of the hand?

[LT_Oneal_PAC]

My only guess is concern for compartment syndrome requiring fasciotomy? Though I wouldnt be as concerned with only involving the fingers. The literature has shown in orthopedic cases that regional blocks have not caused delay in diagnosis in this, postulated alternate pain pathway. I do not know of any contraindications. Possibly concern that it limited their assessment. Would have done the same.

[LT_Oneal_PAC]

On 5/1/2020 at 10:46 AM, ohiovolffemtp said:

Has anyone here heard that nerve blocks are contra-indicated for pain control of severe burns?  I'm asking because the burn referral center to whom I transferred a patient complained to my medical director that the nerve blocks I did "was not the standard of care".  It was an intoxicated young man who fell, putting his hand into a bonfire.  He had severe deep partial thickness burns that were circumferential on multiple fingers.  Right when he came in I gave him radial, median, and ulnar nerve blocks as well as IV opiates once we had access.  His pain was hard to control.  My medical director is very supportive and the literature search I did didn't find any contra-indications.  I've not seen the burn center's reasoning, but I can't think of a contra-indication.  None of the injections were through burned areas.

Any thoughts?

FYI, did a radial block today to debride a posterior hand. So you’re in good company. Talked with the burn center. They didn’t seem to care.

[ohiovolffemtp]

My medical director guessed the same thing - might have delayed their assessment.  His assessment: less opiates in a drunk and high patient - good thing.