ArticleFrontiers in medicine2026
Ultrasound predictors of peripheral nerve block failure after blast injury: a prospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: High-energy blast injuries produce severe anatomical distortion that may compromise ultrasound-guided peripheral nerve blocks (PNBs). However, large-scale data identifying predictors of block failure in this population remain limited. Objective: To determine the incidence and independent predictors of PNB failure in patients with blast-related limb trauma. Methods: Prospective observational cohort study conducted between March 2023 and February 2026 at a tertiary war trauma center. Adult patients undergoing ultrasound-guided PNB for blast-related limb injuries were included. Primary block failure was defined as failure to achieve ≥50% reduction in Numeric Rating Scale (NRS) pain score within 30 min together with incomplete sensory blockade in the expected dermatomal distribution. Rescue opioid requirement within 6 h was analyzed separately as a secondary indicator of analgesic burden. Anatomical distortion variables and injury severity were analyzed. Multivariable logistic regression identified independent predictors of failure. Results: A total of 774 patients were analyzed. Overall block failure rate was 27.8%. Anatomical distortion was present in 64% of cases. Independent predictors of failure included vascular reconstruction (aOR 2.43, 95% CI 1.65-3.58), large hematoma (aOR 1.91, 95% CI 1.43-2.55), scar tissue/adhesions (aOR 1.74, 95% CI 1.29-2.33), fracture displacement (aOR 1.68, 95% CI 1.25-2.24), and Injury Severity Score > 25 (aOR 1.56, 95% CI 1.14-2.13). Conclusion: Anatomical distortion following blast injury significantly increases the risk of PNB failure. Recognition of trauma-specific anatomical predictors is essential for optimizing regional anesthesia strategies in high-energy injury populations.
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