Perineural fresh frozen plasma with local anaesthetics in coagulopathic patients undergoing peripheral nerve blocks: A clinical case series

Peripheral nerve blocks (PNBs) in coagulopathic patients are typically avoided due to the risks of bleeding and potential nerve compression. This case series explores the use of perineural fresh frozen plasma (FFP) to enhance local haemostasis in such settings. Five patients with an international normalised ratio of > 1.8, requiring urgent surgery, received PNBs with perineural FFP after haematology consultation. Seven ultrasound-guided blocks were performed, with FFP injected perineurally and along the needle tract, followed by systemic FFP 20 minutes later. All procedures were completed under PNB without conversion or need for additional analgesia. One patient developed a localised haematoma post-supraclavicular block, resolving after perineural FFP. No neurological deficits, major bleeding, or infections were observed. These preliminary results suggest that perineural FFP may reduce bleeding complications in high-risk patients, though further research is needed. Until validated, its use should remain investigational and be undertaken with multidisciplinary oversight and strict adherence to aseptic technique and ultrasound guidance.