Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA; University of California, San Francisco, CA.
Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA.
Am J Emerg Med. 2014 Mar;32(3):287.e1-3. doi: 10.1016/j.ajem.2013.09.036. Epub 2013 Oct 2.
Regional nerve blocks provide superior analgesia over opioid-based pain management regimens for traumatic injuries such as femur fractures. An ultrasound-guided regional nerve block is placed either as a single-shot injection or via a perineural catheter that is left in place. Although perineural catheters are commonplace in the perioperative setting, their use by emergency physicians (EPs) for emergency pain management in adults has not been previously described. Perineural catheters allow prolonged and titratable delivery of local anesthetic directly targeted to the injured extremity, resulting in opioid sparing while maintaining high-quality pain relief with improved alertness. Despite these advantages, most EPs do not currently place perineural catheters, likely due to the widespread perception that the procedure is both excessively time consuming and too technically difficult to be practical in a busy emergency department (ED). A catheter-over-needle kit, resembling a peripheral intravenous line, is now available and may be familiar to EPs than traditional catheter-needle assemblies. Recent studies also suggest excellent analgesic outcomes with intermittent perineural bolusing of local anesthetic, thereby dispensing with the need for complex and expensive infusion pumps. Herein, we describe our successful placement of perineural femoral catheters at a busy inner-city public hospital ED. Our experience suggests that this is a promising new technique for emergency pain management of acute extremity injuries.
区域神经阻滞在创伤性损伤（如股骨骨折）的疼痛管理中优于基于阿片类药物的治疗方案，提供更好的镇痛效果。超声引导下的区域神经阻滞可单次注射或通过留置在原位的外周神经导管进行。尽管外周神经导管在围手术期很常见，但急诊医师（EP）在成人急诊疼痛管理中使用它们的情况尚未被描述过。外周神经导管允许将局部麻醉剂直接靶向受伤肢体进行长时间和可滴定的输送，从而在保持高质量镇痛的同时节省阿片类药物，提高警觉性。尽管有这些优势，但大多数 EP 目前并没有放置外周神经导管，可能是因为普遍认为该程序既过于耗时，又过于复杂，在繁忙的急诊部门（ED）中不切实际。一种类似于外周静脉输液的导管针套件现在已经可用，可能比传统的导管针组件更让 EP 熟悉。最近的研究还表明，间歇性经外周神经鞘内推注局部麻醉剂可获得良好的镇痛效果，从而无需使用复杂且昂贵的输液泵。在此，我们描述了我们在一家繁忙的市中心公立医院 ED 成功放置外周神经股导管的经验。我们的经验表明，这是一种治疗急性四肢损伤的有前途的新方法。
