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. 2024 Oct-Nov;14(10-11):571-578.
doi: 10.1080/17581869.2024.2431474. Epub 2024 Nov 24.

Ultrasound-guided regional anesthesia (UGRA) in the emergency department: a scoping review

Syed Mohammad J Mahmood  1   2 , Nikhil B Bhana  3 , Clarence Kong  4 , Nik Theyyunni  1 , William J Schaeffer  1   5 , Charles W Kropf  1 , Nicole T Klekowski  1 , Brendan W Munzer  1   6 , Zachary B Rotter  1   7 , Ashley E Hall  1   8 , Jonathan D Porath  1   6 , William J Peterson  1 , Ryan V Tucker  1   9
Affiliations

Ultrasound-guided regional anesthesia (UGRA) in the emergency department: a scoping review

Syed Mohammad J Mahmood et al. Pain Manag. 2024 Oct-Nov.

Abstract

Introduction: While many studies have been published on Ultrasound-guided regional anesthesia in the Emergency Department (ED), there has been no previous study assessing the current state of the literature based in the form of a scoping review.

Objective: The purpose of this study is to evaluate the current state of the literature on UGRA performed in the ED setting.

Methods: EMBASE, MEDLINE, CINAHL, and Cochrane databases were searched for studies. Following PRISMA-ScR guidelines (Figure 1), two reviewers evaluated each title and abstract and were included if they described a UGRA technique performed on patients in the ED by an ED provider. Cohen's kappa coefficients were calculated for each level of review.[Figure: see text].

Results: Of the 1,456 abstracts, a total of 53 articles were included in the analysis, of which 28 (52.8%) were case series and 11 (20.8%) were randomized control trials (RCTs). The most common types of nerve block represented in these studies were femoral nerve/fascia iliaca (14), brachial plexus (7), and forearm (radial, ulnar, median nerves) (7). 47 of the 53 articles were published in or after the year 2010.

Conclusion: Current literature supporting UGRA use in the ED is growing but unbalanced, requiring large population studies to demonstrate safety and efficacy of these techniques.

Keywords: Ultrasound; emergency department; nerve blocks; pain management; regional anesthesiology.

Plain language summary

Pain is one of the most common reasons patients seek care in the Emergency Department (ED), but its management remains a challenge. This manuscript reviews the use of ultrasound-guided regional anesthesia (UGRA) in the ED, focusing on how it offers a safe and effective way to relieve pain while reducing opioid use. Nerve blocks deliver anesthetic directly to specific nerves, helping reduce pain without the side effects commonly associated with opioids, such as sedation and respiratory depression. UGRA has become more feasible with the increasing use of point-of-care ultrasound (POCUS), a core competency for emergency physicians.The review analyzed 53 studies on various nerve block techniques performed in EDs by ED providers. Most studies focus on the femoral nerve block, especially for hip fractures, but other blocks, such as brachial plexus and truncal blocks, are being studied. However, the literature is still imbalanced, with fewer studies on upper extremity and truncal blocks. The majority of studies are case series, and there is a need for more randomized controlled trials and larger patient populations to confirm the efficacy and safety of UGRA across different patient groups.The review calls for future research to expand the scope of nerve blocks studied, especially in underrepresented populations such as pediatric and geriatric patients. It also highlights the need for standardized protocols and outcome measures to allow easier comparison between studies. Expanding the evidence base will help empower ED providers to use UGRA more confidently, improving patient care and reducing opioid use.

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Conflict of interest statement

Nik Theyyunni has received fundingpersonally from 4Catalyzer for consulting, concluded January 2021. Wedo not believe this affected his judgement or the review in anymeaningful way. Theauthors have no other relevant affiliations or financial involvementwith any organization or entity with a financial interest in orfinancial conflict with the subject matter or materials discussed inthe manuscript apart from those disclosed.

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