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Pain Management via Ultrasound-guided Nerve Block in Emergency Department; a Case Series Study

Amir Nejati, Houman Teymourian, Leili Behrooz, Gholamreza Mohseni
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Abstract

Introduction: Pain is the most common complaint of patients referring to emergency department (ED). Considering
the importance of pain management in ED, this study aimed to investigate the efficacy and feasibility of
ultrasound-guided nerve blocks in this setting. Methods: 46 patients who came to the ED with injured extremities
were enrolled in the study and received either femoral, axillary or sciatic nerve block depending on their
site of injury (1.5 mg Bupivacaine per kg of patient’s weight). Patients were asked about their level of pain before
and after receiving the nerve block based on numerical rating scale. The difference between pre and post block
pain severity was measured. Both patients and physicians were asked about their satisfaction with the nerve
block in 5 tiered Likert scale. Results: 46 patients with the mean age of 37.5 § 12.5 years (8-82 years) received
ultrasound-guided nerve block (84.8% male). 6 Sciatic, 25 axillary, and 15 femoral nerve blocks were performed.
Mean pain severity on NRS score at the time of admission was 8.1 § 1.4, which reduced to 2.04 § 2.06 after block.
25 (54.3%) patients were highly satisfied (Likert scale 5), 15 (32.6%) were satisfied (Likert scale 4), 3 (6.5%) were
neutral and had no opinion (Likert scale 3), 1 (2.1%) was not satisfied (Likert scale 2), and 2 (4.3%) were highly
unsatisfied (Likert scale 1). There was no significant difference among the satisfaction scores within the three
block locations (p = 0.8). There was no significant difference in physicians level of satisfaction between the three
block locations either (p = 0.9). 1 (2.1%) case of agitation and tachycardia and 1 (2.1%) case of vomiting were
observed after the procedure. Conclusion: Ultrasound-guided nerve block of extremities is a safe and effective
method that can be used for pain management in the ED. It results in high levels of satisfaction among both
patients and physicians.

Keywords

Nerve Block; Ultrasonography, Interventional; PainManagement; Emergency Service, Hospital

References

Ducharme J. Emergency pain management: a Canadian Association of Emergency Physicians (CAEP) consensus document. The Journal of emergency medicine. 1994;12(6):855-66.

Bhoi S, Chandra A, Galwankar S. Ultrasound-guided nerve blocks in the emergency department. Journal of emergencies, trauma, and shock. 2010;3(1):82.

Stone MB, Wang R, Price DD. Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. The American journal of emergency medicine. 2008;26(6):706-10.

La Grange PdP, Foster P, Pretorius L. Application of the Doppler ultrasound bloodflow detector in supraclavicular brachial plexus block. British Journal of Anaesthesia. 1978;50(9):965-7.

Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesthesia & Analgesia. 1994;78(3):507-13.

Liebmann O, Price D, Mills C, Gardner R, Wang R, Wilson S, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Annals of emergency medicine. 2006;48(5):558-62.

Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. The American journal of emergency medicine. 2010;28(1):76-81.

Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Annals of emergency medicine. 2003;41(2):227-33.

Herring AA, Stone MB, Nagdev AD. Ultrasound-guided abdominal wall nerve blocks in the ED. The American journal of emergency medicine. 2012;30(5):759-64.

Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. The Journal of emergency medicine. 2012;43(4):692-7.

Ferraro LHC, Tardelli MA, Yamashita AM, Cardone JDB, Kishi JM. Ultrasound-Guided Femoral and Sciatic Nerve Blocks in an Anticoagulated Patient. Case Reports. Brazilian Journal of Anesthesiology. 2010;60(4):422-8.

Wang F, Liu L-W, Hu Z, Peng Y, Zhang X-Q, Li Q. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study. Brazilian Journal of Anesthesiology (English Edition). 2015;65(1):14-20.

Shteynberg A, Riina LH, Glickman LT, Meringolo JN, Simpson RL. Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns. 2013;39(1):146-9.

Perov S, Patel P, Kumar S, McKelvey GM, Chidiac E, Motlani F. Effective low dosage of mepivacaine in ultrasound-guided axillary nerve block: a double-blinded, randomized clinical trial of efficacy in patients undergoing distal upper extremity surgery. Journal of clinical anesthesia. 2014;26(3):222-6.

Newton-Brown E, Fitzgerald L, Mitra B. Audit improves Emergency Department triage, assessment, multi-modal analgesia and nerve block use in the management of pain in older people with neck of femur fracture. Australasian Emergency Nursing Journal. 2014;17(4):176-83.

KOSCIELNIAK‐NIELSEN Z. Ultrasound‐guided peripheral nerve blocks: What are the benefits? Acta Anaesthesiologica Scandinavica. 2008;52(6):727-37.

Blaivas M, Adhikari S, Lander L. A Prospective Comparison of Procedural Sedation and Ultrasound‐guided Interscalene Nerve Block for Shoulder Reduction in the Emergency Department. Academic Emergency Medicine. 2011;18(9):922-7.

Wathen JE, Gao D, Merritt G, Georgopoulos G, Battan FK. A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Annals of emergency medicine. 2007;50(2):162-71. e1.

Luber MJ, Greengrass R, Vail TP. Patient satisfaction and effectiveness of lumbar plexus and sciatic nerve block for total knee arthroplasty. The Journal of arthroplasty. 2001;16(1):17-21.




DOI: http://dx.doi.org/10.22037/emergency.v5i1.12642

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