Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA.
Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA.
Ann Emerg Med. 2024 Jan;83(1):14-21. doi: 10.1016/j.annemergmed.2023.08.482. Epub 2023 Sep 23.
Emergency practitioners use ultrasound-guided nerve blocks to alleviate pain. This study represents the largest registry of single-injection ultrasound-guided nerve blocks performed in an emergency department (ED) to date. We wished to assess the safety and pain score reductions associated with ED-performed ultrasound-guided nerve blocks. The main outcomes of interest were ultrasound-guided nerve block complication rates and change in patient-reported pain (0 to 10 on the VAS) pre and post ultrasound-guided nerve blocks. Other variables of interest were ultrasound-guided nerve block types and indications during the study period.
This is a retrospective analysis of 420 emergency practitioner-performed ultrasound-guided nerve blocks through chart review over 1 year in the Highland ED. Four emergency physician abstractors reviewed all templated ultrasound-guided nerve block notes and nursing records over the study period. Inter-rater reliability was assessed using 10 randomly selected charts with 100% agreement for 70 key variables (Kappa=1, P<.001).
Seventy-five unique emergency practitioners performed 420 ultrasound-guided nerve blocks. Ultrasound-guided nerve blocks were most often performed by emergency residents (61.9%), advanced practice practitioners (21.2%), ultrasound fellowship-trained faculty (8.3%), interns (3.6%), nonultrasound fellowship-trained faculty (3.3%), and not recorded (1.7%). One complication occurred during the study (arterial puncture recognized through syringe aspiration without further sequelae). Among the 261 ultrasound-guided nerve blocks with preblock and postblock pain scores, there was an improvement in postblock pain scores. The mean pain scores decreased from 7.4 to 2.8 after an ultrasound-guided nerve block (difference 4.6, 95% confidence interval 3.9 to 5.2).
This 1-year retrospective study supports that emergency practitioner-performed ultrasound-guided nerve blocks have a low complication rate and are associated with reduced pain.
急诊医师使用超声引导下的神经阻滞来缓解疼痛。本研究代表了迄今为止在急诊科进行的单次超声引导下神经阻滞的最大注册研究。我们旨在评估与急诊科实施的超声引导下神经阻滞相关的安全性和疼痛评分降低。主要关注的结果是超声引导下神经阻滞的并发症发生率和患者报告的疼痛（0 到 10 的 VAS 评分）在超声引导下神经阻滞前后的变化。研究期间感兴趣的其他变量包括超声引导下神经阻滞的类型和适应证。
这是一项回顾性分析，对 Highland ED 中 1 年内由 420 名急诊医师进行的 420 例超声引导下神经阻滞进行图表回顾。在研究期间，有 4 名急诊医师摘录员审查了所有模板化的超声引导下神经阻滞记录和护理记录。使用 10 份随机选择的图表，对 100%的 70 个关键变量（Kappa=1，P<.001）进行了组内可靠性评估。
75 名独特的急诊医师进行了 420 例超声引导下神经阻滞。超声引导下神经阻滞最常由急诊住院医师（61.9%）、高级实践医师（21.2%）、超声奖学金培训教师（8.3%）、实习医师（3.6%）、非超声奖学金培训教师（3.3%）和未记录（1.7%）实施。在研究期间发生了 1 例并发症（通过注射器抽吸发现动脉穿刺，无进一步后遗症）。在 261 例有阻滞前和阻滞后疼痛评分的超声引导下神经阻滞中，疼痛评分有所改善。超声引导下神经阻滞后疼痛评分从 7.4 分降至 2.8 分（差异 4.6，95%置信区间 3.9 至 5.2）。
这项为期 1 年的回顾性研究支持急诊医师实施的超声引导下神经阻滞并发症发生率低，并与疼痛减轻相关。
