{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:00Z","timestamp":1783318500293,"version":"3.54.6"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the incidence and independent predictors of PNB failure in patients with blast-related limb trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u226550% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20133.58), large hematoma (aOR 1.91, 95% CI 1.43\u20132.55), scar tissue\/adhesions (aOR 1.74, 95% CI 1.29\u20132.33), fracture displacement (aOR 1.68, 95% CI 1.25\u20132.24), and Injury Severity Score &amp;gt; 25 (aOR 1.56, 95% CI 1.14\u20132.13).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1826698","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:36:37Z","timestamp":1783316197000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound predictors of peripheral nerve block failure after blast injury: a prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dmytro","family":"Dmytriiev","sequence":"first","affiliation":[{"name":"Superhumans War Trauma Center","place":["Lviv, Ukraine"]},{"name":"Department of Anesthesiology and Intensive Care, National Pirogov Memorial Medical University","place":["Vinnytsia, Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1097\/AAP.0000000000000720","article-title":"The third American society of regional anesthesia and pain medicine practice advisory on local anesthetic systemic toxicity: executive summary 2017.","volume":"43","author":"Neal","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1136\/rapm-2021-103136","article-title":"Recommendations for effective documentation in regional anesthesia: an expert panel delphi consensus project.","volume":"47","author":"Ahmed","year":"2022","journal-title":"Reg Anesth Pain Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1097\/TA.0b013e3181a27e7f","article-title":"Injuries from explosions: physics, biophysics, pathology, and required research focus.","volume":"66","author":"Champion","year":"2009","journal-title":"J Trauma."},{"key":"B4","doi-asserted-by":"publisher","first-page":"S311","DOI":"10.1097\/CCM.0b013e31817e2a8c","article-title":"Primary blast injury: update on diagnosis and treatment.","volume":"36","author":"Ritenour","year":"2008","journal-title":"Crit Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1177\/0310057X1804600507","article-title":"Does a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: a randomised controlled trial.","volume":"46","author":"Edwards","year":"2018","journal-title":"Anaesth Int Care."},{"key":"B6","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1002\/ca.24262","article-title":"Optimizing peripheral nerve block placement in hip surgery: a cadaveric study mapping the posterior cutaneous innervation.","volume":"38","author":"Gurney","year":"2025","journal-title":"Clin Anath"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e70185","DOI":"10.1002\/ejp.70185","article-title":"The total pain in Ukraine study: how does war affect civilians with a history of chronic pain? 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