Beals Tyler, Odashima Kay, Haines Lawrence E, Likourezos Antonios, Drapkin Jefferson, Dickman Eitan
Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Rosenberg 2, Boston, MA, 02215, USA.
Maimonides Medical Center, Brooklyn, NY, USA.
Ultrasound J. 2019 Jul 15;11(1):15. doi: 10.1186/s13089-019-0131-x.
The interscalene brachial plexus nerve block (ISNB) is a potentially useful method of regional analgesia for humerus fracture and shoulder dislocation reduction in the Emergency Department (ED). We examined the effectiveness of an ISNB workshop given to emergency medicine (EM) residents. We also explored complication rates and effectiveness of ISNBs performed in the ED.
One-hour evidence-based ISNB workshops were conducted with EM residents. Participants were given pre-, post-, and 3-month post-workshop knowledge and technical assessments. Results were analyzed using descriptive statistics. A pre- and post-workshop chart review examined ISNB utilization, complications, post-ISNB opiate administration, and post-ISNB procedural sedation.
41 residents enrolled in the workshop. Pre-workshop pass rate: knowledge assessment 22%. Immediate post-workshop pass rates: knowledge assessment 100%, image acquisition 93%, needle placement 100%. Three months post-workshop pass rates: knowledge assessment 73%, image acquisition 76%, needle placement 100%. Areas of poorest knowledge retention were anatomical landmarks, block distribution, and early signs of LAST. In the chart review, 2 ISNBs were performed in the pre-workshop period, and 12 in the post-workshop period. No serious complications were recorded. 78.5% of attempted ISNBs were successful, without need for procedural sedation. Of the 11 successfully performed ISNBs, 91% received no opiates after the procedure.
Our study suggests that EM residents can learn the ISNB, perform it safely in the emergency department, and that the ISNB may be an alternative to procedural sedation and opiate use for shoulder dislocation. Residents are adept at ISNB technical skills but demonstrate some deficits in knowledge retention.
肌间沟臂丛神经阻滞（ISNB）是急诊科用于肱骨骨折和肩关节脱位复位的一种潜在有效的区域镇痛方法。我们研究了为急诊医学（EM）住院医师举办的ISNB工作坊的效果。我们还探讨了在急诊科进行ISNB的并发症发生率和有效性。
为EM住院医师举办了为期一小时的循证ISNB工作坊。参与者在工作坊前、工作坊后以及工作坊后3个月接受知识和技术评估。结果采用描述性统计进行分析。通过工作坊前后的图表回顾，检查了ISNB的使用情况、并发症、ISNB后阿片类药物的使用以及ISNB后程序性镇静情况。
41名住院医师参加了工作坊。工作坊前通过率：知识评估22%。工作坊后即时通过率：知识评估100%，图像采集93%，进针100%。工作坊后3个月通过率：知识评估73%，图像采集76%，进针100%。知识保留最差的领域是解剖标志、阻滞分布和局部麻醉中毒（LAST）的早期迹象。在图表回顾中，工作坊前进行了2次ISNB，工作坊后进行了12次。未记录到严重并发症。78.5%的ISNB尝试成功，无需程序性镇静。在11次成功进行的ISNB中，91%在术后未使用阿片类药物。
我们的研究表明，EM住院医师可以学会ISNB，并在急诊科安全实施，并且ISNB可能是肩关节脱位程序性镇静和使用阿片类药物的一种替代方法。住院医师擅长ISNB技术技能，但在知识保留方面存在一些不足。
