Emergency practitioner‑administered ultrasound nerve blocks in the emergency department: A retrospective analysis
Suhrith Bhattaram1
, Varsha S. Shinde2(0000-0001-9623-1847, Ishan Lamba3, Princy Panthoi Khumujam4, Tanvi Snehal Desai5
1Department of Emergency Medicine, Maitland Hospital, Metford, NSW, Australia
2Department of Emergency Medicine, Emergency Medicine, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
3Accident and Emergency, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
4Department of OBGYN, Emergency Medicine, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
5Department of Tanvi Snehal Desai, Emergency Medicine, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Maharashtra, India
Keywords: Emergency medicine, nerve block, regional anesthesia
Abstract
OBJECTIVES: In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician performed USGNBs and changes in patient reported pain (pre and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied.
METHODS: Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre and postpain scores on a Numerical Rating Scale.
RESULTS: The study demonstrated a significant reduction in pain scores post USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively.
CONCLUSION: This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.
How to cite this article: Bhattaram S, Shinde VS, Lamba I, Khumujam PP, Desai TS. Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis. Turk J Emerg Med 2024;24:245-51.