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      • Record: found
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      Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

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          Abstract

          Background:

          Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative.

          Aim:

          Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED).

          Setting and Design:

          Prospective observational study conducted in ED.

          Materials and Methods:

          Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure.

          Statistical analysis:

          Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison.

          Results:

          Fifty US guided nerve blocks were sciatic- 4 (8%), femoral-7 (14%), brachial- 29 (58%), median -6 (12%), and radial 2 (4%) nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10) and at 1 hour was 2(IQR 0-4). Median reduction in VAS score was 7.44 (IQR 8-10(75%), 1-2(25%) ( P=0.0001). Median procedure time was 9 minutes (IQR 3, 12 minutes) and median time to reduction of pain was 5 minutes (IQR 1,15 minutes). No immediate or late complications noticed at 3 months.

          Conclusion:

          Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

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          Most cited references19

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          Ultrasound guidance in regional anaesthesia.

          P Marhofer, Manfred Greher, Stephan Kapral (2004)
          The technology and clinical understanding of anatomical sonography has evolved greatly over the past decade. In the Department of Anaesthesia and Intensive Care Medicine at the Medical University of Vienna, ultrasonography has become a routine technique for regional anaesthetic nerve block. Recent studies have shown that direct visualization of the distribution of local anaesthetics with high-frequency probes can improve the quality and avoid the complications of upper/lower extremity nerve blocks and neuroaxial techniques. Ultrasound guidance enables the anaesthetist to secure an accurate needle position and to monitor the distribution of the local anaesthetic in real time. The advantages over conventional guidance techniques, such as nerve stimulation and loss-of-resistance procedures, are significant. This review introduces the reader to the theory and practice of ultrasound-guided anaesthetic techniques in adults and children. Considering their enormous potential, these techniques should have a role in the future training of anaesthetists.
          Article 0 comments Cited 92 times – based on 0 reviews     Review now
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            Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus.

            M Gosch, S Kapral, Shane P Krafft … (1994)
            We prospectively studied 40 patients (ASA grades I-III) undergoing surgery of the forearm and hand, to investigate the use of ultrasonic cannula guidance for supraclavicular brachial plexus block and its effect on success rate and frequency of complications. Patients were randomized into Group S (supraclavicular paravascular approach; n = 20) and Group A (axillary approach; n = 20). Ultrasonographic study of the plexus sheath was done. After visualization of the anatomy, the plexus sheath was penetrated using a 24-gauge cannula. Plexus block was performed using 30 mL bupivacaine 0.5%. Onset of sensory and motor block of the radial, ulnar, and median nerves was recorded in 10-min intervals for 1 h. Satisfactory surgical anesthesia was attained in 95% of both groups. In Group A, 25% showed an incomplete sensory block of the musculocutaneous nerve, whereas all patients in Group S had a block of this nerve. Complete sensory block of the radial, median, and ulnar nerves was attained after an average of 40 min without a significant difference between the two groups. Because of the direct ultrasonic view of the cervical pleura, we had no cases of pneumothorax. An accidental puncture of subclavian or axillary vessels, as well as neurologic damage, was avoided in all cases. An ultrasonography-guided approach for supraclavicular block combines the safety of axillary block with the larger extent of block of the supraclavicular approach.
            Article 0 comments Cited 70 times – based on 0 reviews     Review now
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              Ultrasound guidance speeds execution and improves the quality of supraclavicular block.

              Patrick Harris, Lisa G Fore Arcand, Monique Ruel … (2003)
              In this prospective study, we assessed the quality, safety, and execution time of supraclavicular block of the brachial plexus using ultrasonic guidance and neurostimulation compared with a supraclavicular technique that used anatomical landmarks and neurostimulation. It was hypothesized that ultrasonic guidance would increase the proportion of successful blocks, decrease block execution time, and reduce the incidence of complications such as pneumothorax and neuropathy. Eighty patients were randomized into two groups of 40, Group US (supraclavicular block guided in real time by a two-dimensional ultrasonic image, with neurostimulator confirmation of correct needle position) and Group NS (supraclavicular block using the subclavian perivascular approach, also with neurostimulator confirmation). Blocks were performed using bupivacaine 0.5% and lidocaine 2% (1:1 vol) with epinephrine 1:200000 as the anesthetic mixture. The onset of motor and sensory block for the musculocutaneous, median, radial, and ulnar nerves was evaluated over a 30 min period. At 30 min 95% of patients in Group US and 85% of patients in Group NS had a partial or complete sensory block of all nerve territories (P = 0.13) and 55% of patients in Group US and 65% of patients in Group NS had a complete block of all nerve territories (P = 0.25). Surgical anesthesia without supplementation was achieved in 85% of patients in Group US and 78% of patients in Group NS (P = 0.28). No patient in Group US and 8% of patients in Group NS required general anesthesia (P = 0.12). The quality of ulnar block was significantly inferior to the quality of block in other nerve territories in Group NS, but not in Group US; the quality of ulnar block was not significantly different between Groups NS and US. The block was performed in an average of 9.8 min in Group NS and 5.0 min in Group US (P = 0.0001). No major complication occurred in either group. We conclude that ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a more complete block than supraclavicular block using anatomic landmarks and neurostimulator confirmation. Ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a block of better quality than supraclavicular block using anatomic landmarks and neurostimulator confirmation.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Emerg Trauma Shock
                Journal ID (publisher-id): JETS
                Title: Journal of Emergencies, Trauma, and Shock
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-2700
                ISSN (Electronic): 0974-519X
                Publication date (Print): Jan-Mar 2012
                Volume: 5
                Issue: 1
                Pages: 28-32
                Affiliations
                [1]Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
                [1 ]Department of Surgery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
                [2 ]Department of Emergency Medicine, Lady Harding Medical College, New Delhi, India
                [3 ]Department of Emergency Medicine, University of South Florida, Tampa, USA
                Author notes
                Address for correspondence: Dr. Sanjeev Bhoi, E-mail: sanjeevbhoi@ 123456gmail.com
                Article
                Publisher ID: JETS-5-28
                DOI: 10.4103/0974-2700.93107
                PMC ID: 3299149
                PubMed ID: 22416151
                SO-VID: 591a9582-51df-4d4e-b251-5a1b0eaed381
                Copyright © Copyright: © Journal of Emergencies, Trauma, and Shock
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 March 2011
                Date accepted : 06 December 2011
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: nerve block,ultrasound,emergency department
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: nerve block, ultrasound, emergency department

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