Ultrasound-Guided Nerve Blocks: Suggested Procedural Guidelines for Emergency Physicians

Brown, Joseph; Goldsmith, Andrew J.; LaPietra, Alexis; Zeballos, Jose; Stone, Alexander B.; Knight, Rebecca; Carnell, Jennifer; Nagdev, Arun

doi:10.24908/pocus.v7i2.15233

Cited by 8 publications

(2 citation statements)

References 55 publications

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“…Systemic analgesics and sedatives that are commonly used to treat acute and positional pain in hip fractures include opioids, non-steroidal anti-inflammatory drugs (NSAIDs), ketamine, dexmedetomidine, etc., and each group of drugs is known to cause specific adverse effects, especially in the elderly population, like respiratory depression, urinary retention, sedation, cognitive impairment, delirium, acute kidney injury, emergence reactions, and bradycardia [2,3,6]. Ultrasound-guided peripheral nerve blocks have become the standard of care in treating acute pain, procedural pain, and as a part of anesthetic management for hip fractures, as they provide superior analgesia with minimal adverse effects [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study

Jeevendiran,

Suganya,

Sujatha

et al. 2024

Cureus

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Introduction: Hip fractures cause severe pain during positioning for spinal anesthesia (SA). Intravenous systemic analgesics can lead to various complications in elderly patients, hence peripheral nerve blocks are emerging as a standard of care in pain management for hip fractures, among which femoral nerve block (FNB) is widely known and practiced. Pericapsular nerve group (PENG) block is a recently described technique that blocks the articular nerves of the hip with motor-sparing effects and is used to manage positional pain in hip fractures. This study aims to evaluate the analgesic efficacy of PENG block over FNB in managing pain during positioning before SA in hip fractures. Materials and methods: This was a prospective, randomized, double-blinded study. After ethical clearance, 70 patients undergoing hip fracture surgery under SA in a tertiary-care hospital were recruited and randomized to receive either ultrasound-guided PENG block or FNB with 20 ml of 0.25% bupivacaine before performing SA. We compared pain severity using the visual analog scale (VAS) 15 and 30 minutes after the block and during positioning. The sitting angle, requirement of rescue analgesia for positioning, and anesthesiologist and patient satisfaction scores were also analyzed. Continuous data were analyzed with an unpaired t-test while the chi-square test was used for categorical data. Results: There was a significant reduction in VAS scores after PENG block (PENG: 0.66 ± 1.05 and FNB: 1.94 ± 1.90; p = 0.001) with lesser requirement of rescue analgesia for positioning compared to FNB. The anesthesiologist and patient satisfaction scores were also significantly better in the PENG group. Conclusion: PENG block offers better analgesia for positioning before SA than FNB without any significant side effects, and improves patient and anesthesiologist satisfaction, thus proving to be an effective analgesic alternative for painful hip fractures.

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Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study

Jeevendiran,

Suganya,

Sujatha

et al. 2024

Cureus

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“…Regional anaesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades (Hernandez & de Haan, 2022). The objective is to improve the ef f ectiveness of ultrasound -guided nerve blocks perf ormed by trained personnel, as a key element of multimodal pain management regimens in the ED (Brown et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Skills, and Ability on SME Performance: A Systematic Literature Review Authors Dorris Yadewani

Yadewani,

Durai Pandi,

Rahayu

2024

IJMHS

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Complication Rates After Ultrasonography-Guided Nerve Blocks Performed in the Emergency Department

Goldsmith,

Driver,

Duggan

et al. 2024

JAMA Netw Open

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ImportanceUltrasonography-guided nerve blocks (UGNBs) have become a core component of multimodal analgesia for acute pain management in the emergency department (ED). Despite their growing use, national adoption of UGNBs has been slow due to a lack of procedural safety in the ED.ObjectiveTo assess the complication rates and patient pain scores of UGNBs performed in the ED.Design, Setting, and ParticipantsThis cohort study included data from the National Ultrasound-Guided Nerve Block Registry, a retrospective multicenter observational registry encompassing procedures performed in 11 EDs in the US from January 1, 2022, to December 31, 2023, of adult patients who underwent a UGNB.ExposureUGNB encounters.Main Outcomes and MeasuresThe primary outcome of this study was complication rates associated with ED-performed UGNBs recorded in the National Ultrasound-Guided Nerve Block Registry from January 1, 2022, to December 31, 2023. The secondary outcome was patient pain scores of ED-based UGNBs. Data for all adult patients who underwent an ED-based UGNB at each site were recorded. The volume of UGNB at each site, as well as procedural outcomes (including complications), were recorded. Data were analyzed using descriptive statistics of all variables.ResultsIn total, 2735 UGNB encounters among adult patients (median age, 62 years [IQR, 41-77 years]; 51.6% male) across 11 EDs nationwide were analyzed. Fascia iliaca blocks were the most commonly performed UGNBs (975 of 2742 blocks [35.6%]). Complications occurred at a rate of 0.4% (10 of 2735 blocks). One episode of local anesthetic systemic toxicity requiring an intralipid was reported. Overall, 1320 of 1864 patients (70.8%) experienced 51% to 100% pain relief following UGNBs. Operator training level varied, although 1953 of 2733 procedures (71.5%) were performed by resident physicians.Conclusions and RelevanceThe findings of this cohort study of 2735 UGNB encounters support the safety of UGNBs in ED settings and suggest an association with improvement in patient pain scores. Broader implementation of UGNBs in ED settings may have important implications as key elements of multimodal analgesia strategies to reduce opioid use and improve patient care.

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Ultrasound-Guided Nerve Blocks: Suggested Procedural Guidelines for Emergency Physicians

Cited by 8 publications

References 55 publications

Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study

Comparative Evaluation of Analgesic Efficacy of Ultrasound-Guided Pericapsular Nerve Group Block and Femoral Nerve Block During Positioning of Patients With Hip Fractures for Spinal Anesthesia: A Prospective, Double-Blind, Randomized Controlled Study

Knowledge, Skills, and Ability on SME Performance: A Systematic Literature Review Authors Dorris Yadewani

Complication Rates After Ultrasonography-Guided Nerve Blocks Performed in the Emergency Department

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