Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

Abstract

Background:Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative.Aim:Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED).Setting and Design:Prospective observational study conducted in ED.Materials and Methods:Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure.Statistical analysis:Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison.Results:Fifty US guided nerve blocks were sciatic- 4 (8%), femoral-7 (14%), brachial- 29 (58%), median -6 (12%), and radial 2 (4%) nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10) and at 1 hour was 2(IQR 0-4). Median reduction in VAS score was 7.44 (IQR 8-10(75%), 1-2(25%) (P=0.0001). Median procedure time was 9 minutes (IQR 3, 12 minutes) and median time to reduction of pain was 5 minutes (IQR 1,15 minutes). No immediate or late complications noticed at 3 months.Conclusion:Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

Application of Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Same-Day Surgery

“…In recent years, ultrasound technology has been applied for nerve block techniques [12]. Thallaj et al [13] reported high success rates, good anesthesia effects, and high patient satisfaction with ultrasound-guided obturator nerve block, and Bhoi et al [14] achieved satisfactory effects with ultrasoundguided nerve block for limb trauma in emergency patients. Thomas et al [15] showed that the ultrasound-guided interscalene brachial plexus block was safe and effective and that the time to onset of the sensory and motor block was shorter than that in blocks performed using a nerve stimulator.…”

Ultrasound-Guided Forearm Nerve Blocks: A Novel Application for Pain Control in Adult Patients with Digit Injuries

“…Alternative methods of analgesia and anesthesia include procedural sedation and regional nerve blocks. Procedural sedation requires monitoring during and after the procedure, places increased demands on staff, has a number of associated risks, increases ED length of stay, and is generally unnecessary for adequate reduction [1, 2]. …”

Postoperative Analgesia Following Sciatic Nerve Blockade Administered by Nurse Anesthetists Supervised by Regional Anesthesia Faculty in an Academic Hospital

“…There has been an exponential growth in the number of epidural, facet joint and transforaminal injections of the lumbar spine performed by providers not formally trained in anesthesiology [11]. Analyses have focused on complication rates and safety but little is known of the quality of the analgesia following peripheral and neuraxial nerve blockade techniques performed by non-anesthesiologist practitioners [12,13].…”