Written by Christopher Thom
Spoon Feed
This multi-institutional cohort study of 2,735 ultrasound-guided nerve blocks provides strong foundational evidence that these procedures are highly efficacious and associated with very low complication rates.
Put away opioids. Pull out ultrasound.
In this retrospective cohort study, the authors established an Ultrasound Guided Nerve Block Registry consisting of 11 EDs. Ultrasound guided nerve blocks (UGNBs) that occurred in the two year period of 2022 and 2023 were reviewed for efficacy and complications. The distribution of UGNB type varied, with fascia iliaca – see clip below (36%), erector spinae (15%), and forearm blocks (9%) being the most common. Efficacy was assessed by a reduction in patient reported pain, with 70.8% experiencing 51% to 100% pain relief. Overall complications occurred in 0.4% of the cohort, with one major complication (0.04%) secondary to local anesthetic systemic toxicity (LAST) that required intralipid therapy. The remainder of complications largely involved transient numbness or weakness, which are known transient phenomena of certain UGNBs. There were no nerve injury cases identified in the cohort.
How will this change my practice?
The evidence to support ED physician-performed UGNBs continues to expand. UGNBs are efficacious, and complications are rare. The data does predominantly come from academic sites, but many physicians reported having performed only a limited number of blocks beforehand. At a time when our specialty’s focus lies far too heavily on metrics such as LWBS and LOS, the UGNB reminds us that we should keep an eye on adoption of promising and efficacious therapies. There will always be too many tasks to wrestle with on shift. With evidence mounting, it’s time to learn this skill and deploy it to our patients in need.
Ultrasound Guided Nerve Block Pro-Tips:
Start with the easier blocks to gain confidence and skill with ultrasound needle guidance. The forearm blocks are technically easy due to the well visualized nerves and superficial anatomy. They can work well for foreign body extractions, laceration repairs, and certain fracture reductions. Consider them a stepping stone to the deeper or more proximal blocks. The long-axis ultrasound needle approach allows for fantastic needle visualization and is the standard approach for nerve blocks. However, be mindful that increasing depth and an increased needle angle will lead to reduced visualization. There are a host of online resources and in-person courses that can assist in gaining this skillset. And while we must be mindful of complications including LAST toxicity, the current study provides solid evidence that these blocks are safe and effective.
Source
Complication Rates After Ultrasonography-Guided Nerve Blocks Performed in the Emergency Department. JAMA Netw Open. 2024 Nov 4;7(11):e2444742. doi: 10.1001/jamanetworkopen.2024.44742. PMID: 39535792
