Department of Emergency Medicine, Northside Hospital-Forsyth, Cuming, GA, USA.
Acad Emerg Med. 2011 Sep;18(9):922-7. doi: 10.1111/j.1553-2712.2011.01140.x. Epub 2011 Aug 30.
Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one-on-one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups.
This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fisher's exact test, and continuous variables were analyzed using the Wilcoxon rank sum test.
Forty-two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US-guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one-on-one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US-guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49).
In this study, patients undergoing shoulder dislocation reduction using US-guided interscalene block spent less time in the ED and required less one-on-one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients.
急诊医师（EP）开始使用超声（US）引导来进行区域神经阻滞。本研究的主要目的是比较随机接受 US 引导下锁骨下肌阻滞或程序镇静以促进急诊科（ED）肩部脱位复位的患者的住院时间（LOS）。次要目标是比较两组之间的医护人员一对一时间、患者复位过程中的疼痛程度和患者满意度。
这是一项前瞻性、随机研究，纳入了在 ED 就诊的肩部脱位患者。该研究在一家学术性一级创伤中心 ED 进行，每年的就诊人数约为 8 万。如果患者年龄至少 18 岁且需要复位肩部脱位，则符合本研究的纳入标准。采用便利抽样法将患者随机分为传统程序镇静或 US 引导下锁骨下神经阻滞。程序镇静仅使用依托咪酯作为单一药物。锁骨下肌阻滞由具有医院认证的 EP 使用无菌技术和 SonoSite MicroMaxx US 机器与高频线性阵列换能器进行。分类变量采用 Fisher 确切检验进行评估，连续变量采用 Wilcoxon 秩和检验进行分析。
共纳入 42 例患者，每组 21 例。两组在性别或年龄方面无显著差异。程序镇静组的 ED 平均（±SD）住院时间（177.3±37.9 分钟）明显长于 US 引导下锁骨下肌阻滞组（100.3±28.2 分钟；p＜0.0001）。镇静组的医护人员一对一时间平均（±SD）为 47.1（±9.8）分钟，US 引导下锁骨下肌阻滞组为 5（±0.7）分钟（p＜0.0001）。两组患者在满意度或手术过程中的疼痛程度方面无统计学差异。两组在并发症（如缺氧或低血压）方面无显著差异（p=0.49）。
在这项研究中，与接受程序镇静的患者相比，接受 US 引导下锁骨下肌阻滞的肩部脱位复位患者在 ED 中花费的时间更少，所需的医护人员一对一时间更少。与程序镇静患者相比，其疼痛程度或满意度无差异。
