(P2-78a) Feasibility and Safety of Ultrasonography-Guided Nerve Blocks Performed by Emergency Physicians in the Emergency Department

Abstract

Background

Emergency physicians often encounter patients who require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries like fracture reduction, joint dislocation reduction, wound care, and pain relief. Its complications include airway or circulatory compromise. Ultrasound (US) guided peripheral nerve block is a safe alternative that utilizes minimal amounts of local anesthetic and does not require hemodynamic monitoring or prolonged post-procedure observation.

Objective

The objective of this study is to determine the feasibility and safety of ultrasonography-guided nerve blocks, performed by emergency physicians.

Methods

A prospective study involving 28 patients > 12 years of age presenting to an emergency department (ED) were recruited after informed consent. Ultrasonography-guided nerve blocks were performed by emergency physicians who underwent a minimal training of 10 supervised nerve blocks. Brachial plexus, forearm, and lower-limb nerve blocks were performed as deemed necessary. Verbal analogue scale (VAS) was used to quantify pain, before and five minutes after the procedure. The outcomes for feasibility and safety were the percentage of cases in which no further anesthesia was required, the median reduction in VAS score, median time to completion of procedure and the complication rate noted during the procedure.

Results

All procedures were completed without additional anesthesia. The different nerve blocks performed were brachial plexus (20 cases, 71.4%), forearm (3 cases, 10.7%), femoral (2 cases, 7.1%), combined femoral and sciatic (2 cases, 7.1%) and tibial (1 case, 3.6%). Median reduction in VAS score was 7.0 points (interquartile range 6.0, 8.0; p < 0.001). The median time to completion of nerve blocks was 5 minutes per patient (interquartile range 2 minutes 25 seconds, 10 minutes 0 seconds). There were no immediate complications noted after the procedure.

Conclusions

Emergency physicians with minimal training can perform ultrasonography-guided nerve blocks safely, quickly and without the need for additional anesthesia in the ED.