Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts; Department of Hospital Medicine, Massachusetts General Hospital, Boston, Massachusetts.
J Emerg Med. 2021 Apr;60(4):512-516. doi: 10.1016/j.jemermed.2020.10.047. Epub 2020 Dec 15.
Adequate analgesia is difficult to achieve in patients with an abscess requiring incision and drainage (I&D). There has been a recent increase in regional anesthesia use in the emergency department (ED) to aid in acute musculoskeletal pain relief. Specifically, transgluteal sciatic nerve (TGSN) block has been used as an adjunct treatment for certain chronic lumbar and lower extremity pain syndromes in the ED.
A 21-year-old woman presented to the ED with a painful gluteal abscess. The pain was so severe that the patient barely tolerated light palpation to the abscess area. Using dynamic ultrasound guidance, a TGSN block was performed with significant pain reduction. Ultrasonographic confirmation of abscess was obtained followed by definitive I&D. She was discharged from the ED and her incision site was healing well at the time of follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abscess I&D is a common procedure in the ED. Procedural analgesia for I&D can be difficult to obtain. We describe the TGSN block as an additional analgesic option to be used for procedural analgesia. The use of regional anesthesia has the potential to decrease unwanted and at times dangerous side effects of opiate use and resource utilization of procedural sedation while optimizing patient comfort.
脓肿切开引流术（I&D）患者的镇痛效果往往难以令人满意。最近，在急诊科（ED）中，区域麻醉的应用有所增加，以帮助缓解急性肌肉骨骼疼痛。具体而言，经臀坐骨神经（TGSN）阻滞已被用作 ED 中某些慢性腰腿痛综合征的辅助治疗。
一名 21 岁女性因臀部脓肿疼痛就诊于 ED。疼痛非常剧烈，以至于患者几乎无法忍受对脓肿区域的轻度触诊。使用动态超声引导，对 TGSN 阻滞进行了操作，疼痛明显减轻。随后进行了脓肿的超声确认，并进行了确定性 I&D。患者从 ED 出院，随访时切口愈合良好。
为什么急诊医生应该了解这一点？脓肿切开引流术是 ED 中的常见操作。切开引流术的程序镇痛往往难以获得。我们将 TGSN 阻滞描述为一种额外的镇痛选择，用于程序镇痛。使用区域麻醉有可能减少阿片类药物使用的不必要且有时危险的副作用，以及程序镇静的资源利用，同时优化患者舒适度。
