Ultrasonography-Guided Nerve Blocks Safe in Emergency Care

TOPLINE: 

Ultrasonography-guided nerve blocks (UGNBs) performed in emergency departments are associated with a remarkably low complication rate of 0.4% across nearly 2800 procedures, with a high proportion of patients experiencing substantial pain relief, new research shows.

METHODOLOGY:

• Researchers analyzed data from the National Ultrasound-Guided Nerve Block Registry to define both safety and efficacy profiles of blocks performed in US emergency departments for acute pain conditions.
• They included 2735 patient encounters across 11 emergency departments from January 2022 to December 2023; participants were adults aged 18 years or older (48.3% women) who underwent UGNBs.
• A total of 2742 blocks were documented, with data available for 2560 cases; most of the blocks were used for pain control (89.7%).
• Nearly 40% of the blocks were performed by clinicians who had completed more than 20 procedures in the past.
• The primary outcome measures focused on complication rates; the secondary outcomes assessed were patient pain scores.

TAKEAWAY:

• Among the 2742 blocks performed, fascia iliaca or femoral nerve blocks were most common (35.6%), followed by erector spinae plane blocks (14.6%) and forearm nerve blocks (8.8%).
• Complications occurred in 10 cases (0.4%), with only one major complication involving local anesthetic systemic toxicity requiring intralipid administration and nine minor complications including hoarseness, breathing difficulty, and transient nerve-related symptoms.
• Pain relief was substantial, with 70.8% of 1864 patients with documented pain scores experiencing a 51%-100% reduction in pain and 11.3% reporting minimal or no improvement in pain scores.
• Most procedures (71.5%) were performed by resident physicians under supervision, demonstrating the feasibility of implementing these blocks in teaching hospital settings.

IN PRACTICE:

“Data from this registry support the scaling of UGNB [ultrasound-guided nerve block] training and performance across EDs nationally. The findings advocate the widespread adoption of UGNB training and practice across acute care settings, offering a promising avenue for multimodal analgesia strategies that potentially would reduce opioid use and improve patient care,” the authors of the study wrote.

“While the large overall number performed and low rate of complications are promising, the study also highlights the critical need for further efforts to enhance UGNB uptake across sites to ensure adequate skill acquisition and maintenance,” Michael Gottlieb, MD, of Rush University Medical Center, Chicago, wrote in an editorial accompanying the journal article.

SOURCE:

The study was led by Andrew Goldsmith, MD, MBA, of the Department of Emergency Medicine at Lahey Hospital and Medical Center and the University of Massachusetts Chan Medical School, in Burlington, Massachusetts. It was published online on November 13, 2024, in JAMA Network Open.

LIMITATIONS: 

As an observational retrospective study, the research was susceptible to potential reporting bias and missing data points. Most participating sites were academic centers, which could have limited the generalizability of the findings. The reliance on electronic medical records to capture delayed complications may have missed complications if patients sought care at facilities without data-sharing capabilities.

DISCLOSURES:

No funding information was provided for the study. Some authors reported being medical directors, serving as vice presidents, receiving consulting fees or training fees, or having other ties with pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.