Identification of teaching priorities for ultrasound-guided regional anesthesia as first-line pain management in a swiss university emergency department

Abstract

Background: About half of the patients who visit our emergency Department (ED) complain of pain. Since early and consequent pain relief is of great importance, we started to introduce a first-line pain control by ultrasound-guided regional anesthesia. The aim of this study was to identify teaching priorities for ultrasoundguided regional anesthesia (USRA) in the ED. Methods: We included ED-patients with pain of different causes. Exclusion criteria were refusal by the patient or the specialist physician, infection at the injection site, and allergies to local anesthetics (LA). Ultrasonographic guided LA was placed into the compliant epineural space of the targeted nerval structure. Only single-shot USRA was applied. Interventions were performed by two emergency physicians and one emergency fellow resident. Results: We included 322 patients, median age 64.6 years (min. 18, max. 103). Pathologies: fractures 180 (55.9%), soft tissue injuries 45(14%), dislocated joints 44(13.7%), infections 27(8.4%), arthralgia 12(3.7%), neuralgia of the trunk 7(2.2%), acute ischemia 6(1.9%), one complex regional pain syndrome (0.3%). No complications were observed. Conclusion: Main indications for USRA in our ED are fractures and soft tissue injuries of the extremities. Therefore, our future teaching priority will focus on USRA of interscalenic, supraclavicular/axillar plexus, and femoral as well as obturator nerve.

Bringing Ultrasound‐guided Regional Anesthesia to Emergency Medicine

“…From the perspective of an experienced emergency physician, new skills such as UGRA can, at first glance, appear unnecessary. Schöll et al . report a fascinating and instructive experience at a single ED, with 50,000 annual visits, where three of the primary faculty became trained in UGRA.…”