Assessing the Clinical Impact of Emergency Physician-performed Ultrasound-guided Peripheral Nerve Blocks in a Level 1 Trauma Center: A Retrospective Analysis

Abstract

Introduction: Effective pain management is crucial in the emergency department (ED), particularly for trauma patients. Ultrasound-guided regional analgesia (UGRA) has emerged as a promising technique for acute pain relief. The objective of this study is to describe the various UGRA performed and assess their effectiveness among trauma patients in our Level 1 Trauma Center ED over the past 2.5 years.

Methods: Data from 485 trauma patients who underwent UGRA over 2.5 years were analyzed retrospectively. The primary outcome was the median Defense and Veterans Pain Rating Scale (DVPRS) reduction at 30 min and 1 h after nerve block administration. Patient characteristics, types of nerve blocks administered, procedural details, and outcomes were also noted. Statistical analysis was performed to determine the median reduction in pain scores and evaluate the success of UGRA.

Results: UGRA demonstrated a significant reduction in pain scores, with a median DVPRS decrease from 9 (interquartile range [IQR]: 9-10) preprocedure to 4 (IQR: 2-5) at 30 min and 1 (IQR: 0-2) at 1 h postprocedure. Sixteen types of nerve blocks were administered in our ED, with the serratus anterior block (n = 91) and fascia iliaca compartment block (n = 58) being the most common. Pain relief was the most common indication for block administration. A higher volume was injected for plane blocks compared to nerve-specific blocks. No complications or failed blocks were reported.

Conclusion: This study describes 16 different UGRA that can be performed by emergency physicians (EPs) in ED for trauma patients. UGRA is effective in providing substantial pain relief for trauma patients in the ED. UGRA performed by EPs offers a safe and feasible approach for managing acute pain in the ED.

Keywords: Emergency department; pain management; retrospective study; trauma patients; ultrasound-guided regional analgesia.

Figure 1

Approach to nerve block in emergency department. FICB: Fascia iliaca compartment block

Figure 2

Ergonomics during nerve block. Demonstrated on a volunteer. (a) Physician, ultrasound probe, and the screen are in a straight line. (b) Using in-plane approach, the nerve block needle is inserted under ultrasound guidance (needle cap used instead of needle)