Department of Emergency Medicine, Lahey Hospital and Medical Center, University of Massachusetts Chan Medical School, Burlington.
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2024 Nov 4;7(11):e2444742. doi: 10.1001/jamanetworkopen.2024.44742.
Ultrasonography-guided nerve blocks (UGNBs) have become a core component of multimodal analgesia for acute pain management in the emergency department (ED). Despite their growing use, national adoption of UGNBs has been slow due to a lack of procedural safety in the ED.
To assess the complication rates and patient pain scores of UGNBs performed in the ED.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included data from the National Ultrasound-Guided Nerve Block Registry, a retrospective multicenter observational registry encompassing procedures performed in 11 EDs in the US from January 1, 2022, to December 31, 2023, of adult patients who underwent a UGNB.
UGNB encounters.
The primary outcome of this study was complication rates associated with ED-performed UGNBs recorded in the National Ultrasound-Guided Nerve Block Registry from January 1, 2022, to December 31, 2023. The secondary outcome was patient pain scores of ED-based UGNBs. Data for all adult patients who underwent an ED-based UGNB at each site were recorded. The volume of UGNB at each site, as well as procedural outcomes (including complications), were recorded. Data were analyzed using descriptive statistics of all variables.
In total, 2735 UGNB encounters among adult patients (median age, 62 years [IQR, 41-77 years]; 51.6% male) across 11 EDs nationwide were analyzed. Fascia iliaca blocks were the most commonly performed UGNBs (975 of 2742 blocks [35.6%]). Complications occurred at a rate of 0.4% (10 of 2735 blocks). One episode of local anesthetic systemic toxicity requiring an intralipid was reported. Overall, 1320 of 1864 patients (70.8%) experienced 51% to 100% pain relief following UGNBs. Operator training level varied, although 1953 of 2733 procedures (71.5%) were performed by resident physicians.
The findings of this cohort study of 2735 UGNB encounters support the safety of UGNBs in ED settings and suggest an association with improvement in patient pain scores. Broader implementation of UGNBs in ED settings may have important implications as key elements of multimodal analgesia strategies to reduce opioid use and improve patient care.
超声引导下的神经阻滞 (UGNB) 已成为急诊科 (ED) 急性疼痛管理中多模式镇痛的核心组成部分。尽管它们的使用越来越多，但由于 ED 中程序安全性的缺乏，UGNB 的全国性采用一直很缓慢。
评估 ED 中进行的 UGNB 的并发症发生率和患者疼痛评分。
设计、地点和参与者：这项队列研究的数据来自国家超声引导神经阻滞登记处，这是一个回顾性多中心观察性登记处，涵盖了 2022 年 1 月 1 日至 2023 年 12 月 31 日期间在美国 11 个 ED 进行的成人患者的 UGNB 手术。
UGNB 手术。
本研究的主要结果是记录在国家超声引导神经阻滞登记处的 2022 年 1 月 1 日至 2023 年 12 月 31 日期间 ED 进行的 UGNB 相关的并发症发生率。次要结果是 ED 进行的 UGNB 的患者疼痛评分。记录了每个地点所有接受 ED 基础 UGNB 的成年患者的数据。每个地点的 UGNB 量以及程序结果（包括并发症）都被记录下来。使用所有变量的描述性统计数据进行数据分析。
在全国范围内的 11 个 ED 中，共分析了 2735 名成年患者（中位数年龄为 62 岁[IQR，41-77 岁]；51.6%为男性）的 UGNB 手术。股神经筋膜阻滞是最常进行的 UGNB（2742 块中的 975 块[35.6%]）。并发症发生率为 0.4%（10/2735 块）。报告了 1 例需要脂肪乳剂治疗的局部麻醉全身毒性事件。总体而言，1864 名患者中有 1320 名（70.8%）在接受 UGNB 后疼痛缓解了 51%至 100%。操作人员的培训水平各不相同，尽管 2733 例手术中有 1953 例（71.5%）由住院医师完成。
这项对 2735 例 UGNB 手术的队列研究结果支持 ED 环境中 UGNB 的安全性，并表明与患者疼痛评分的改善有关。ED 中更广泛地实施 UGNB 可能具有重要意义，因为它们是减少阿片类药物使用和改善患者护理的多模式镇痛策略的关键要素。
