• Connor Ta Brenna, Shawn Khan, Rita Katznelson, and Richard Brull.
• Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada connor.brenna@mail.utoronto.ca.
• Reg Anesth Pain Med. 2023 Sep 1; 48 (9): 443453443-453.

Background/ImportancePeripheral nerve injury is an uncommon but potentially catastrophic complication of anesthesia and surgery, for which there are limited effective treatment options. Hyperbaric oxygen therapy is a unique medical intervention which improves tissue oxygen delivery and reduces ischemia via exposure to oxygen at supra-atmospheric partial pressures. While the application of hyperbaric oxygen therapy has been evidenced for other medical conditions involving relative tissue ischemia, its role in the management of peripheral nerve injury remains unclear.ObjectiveThis scoping review seeks to characterize rehabilitative outcomes when hyperbaric oxygen therapy is applied as an adjunct therapy in the treatment of perioperative peripheral nerve injury.Evidence ReviewThe review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews, using a systematic screening and extraction process. The search included articles published from database inception until June 11, 2022, which reported clinical outcomes (in both human and non-human models) of peripheral nerve injury treated with hyperbaric oxygen therapy.FindingsA total of 51 studies were included in the narrative synthesis. These consisted of animal (40) and human studies (11) treating peripheral nerve injury due to various physiological insults. Hyperbaric oxygen therapy protocols were highly heterogenous and applied at both early and late intervals relative to the time of peripheral nerve injury. Overall, hyperbaric oxygen therapy was reported as beneficial in 88% (45/51) of included studies (82% of human studies and 90% of animal studies), improving nerve regeneration and/or time to recovery with no reported major adverse events.ConclusionsExisting data suggest that hyperbaric oxygen therapy is a promising intervention in the management of perioperative peripheral nerve injury, in which tissue ischemia is the most common underlying mechanism of injury, neurological deficits are severe, and treatment options are sparse. This positive signal should be further investigated in prospective randomized clinical trials.© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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