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Regional analgesia, nerve block, in painful neuropathy

Until recently, regional anesthesia provided for the patient with a preexisting neuropathy has received scant attention. A review of major reference works dedicated to regional anesthesia spanning 87 years, and more than 4,700 total pages, found only 5 pages wherein the issue of central neuraxial anesthesia or PNB was discussed in the context of neuropathy. 

 This is the introduction of a recent paper: Regional Anesthesia And the Patient With Preexisting Neuropathy, by KENNETH D. CANDIDO, MD in PAIN MEDICINE NEWS.COM • FEBRUARY 2010.

The author quotes a recent anesthesiological paper, were the statement could be read that “The most conservative legal approach is to avoid regional anesthesia in these [ie, preexisting neurologic-disordered] patients. … The decision to proceed with regional anesthesia in these [ie, high-risk] patients should be made on a case-by- case basis.  

Not yet the time for regional analgesia in neuropathic pain 

The author reviews the topic of regional analgesia in a variety of neuropathies and comes to a somewhat negative conclusion:

No absolute method exists for predicting how the patient with a preexisting neuropathy will fare with a regional block technique. Whether the neuropathy will remain static or become exacerbated is uncertain. Each case must be evaluated individually, and a full appraisal of the risks and benefits associated with and the alternatives to regional anesthesia must be provided to the patient.  

For the time being there is not enough evidence for the safety of regional blocks in neuropathic pain, that would be our reading.

Jan M. Keppel Hesselink, MD, PhD, March 2010