![]() ![]() ![]() Numerous studies have found that patients treated with nerve blocks for varied painful conditions have better self-reported pain scores and reduced in-hospital opioid requirements. Īn immediate secondary benefit when RA is used to treat acute pain is decreased consumption of opioids. Femoral nerve blocks (FNBs) were also shown to decrease overall mortality when administered to patients with hip fractures presenting from the community. A systematic review of 83 studies found, when compared to other pain control modalities, only RA-controlled acute pain in hip fractures and was more effective than other approaches. Most traumatic injuries are initially managed in the ED, rendering EPs best positioned to provide rapid RA to these patients. ĭata suggests RA is most effective for patients with traumatic injuries when performed as early as possible following injury. In this same study, patients who underwent reduction with IV morphine alone reported significantly greater pain during and after reduction compared to the RA group. ![]() Another randomized, three-way comparison of general anesthesia versus IV anesthesia versus interscalene block for shoulder reduction found no difference in efficacy between the three but shortened LOS and high patient satisfaction in the block group. A study comparing patients who underwent shoulder reduction using procedural sedation versus EP-placed USGRA interscalene block found that the latter group had shorter LOS and required less face-to-face provider time without any significant detriment to pain control or satisfaction compared to the control group. Additional benefits include decreased length of stay (LOS), elimination of the need for procedural sedation, lower in-hospital cost, and overall high patient satisfaction compared to other pain management methods. In patients with traumatic injuries, use of RA has shown improvement in morbidity and mortality related to rib, hip, and femur fractures. RA allows for highly specific, localized pain control and anesthesia without the side effects of respiratory depression, hemodynamic instability, altered mentation, or delirium. The obvious benefit of RA in the ED patient population is fast, effective analgesia. Table 2 contains basic information on anesthetics commonly used in performing RA in the ED.įull size table Benefits of RA Administered in the ED Detailed instruction on performing specific blocks is outside the scope of this review Table 1 contains hyperlinks to further information on common ED RA procedures. This review covers the benefits of RA in the ED population, best practices for RA administration and training, evidence behind those practices, most common types of RA performed by EPs, and future of this invaluable tool. The body of literature supporting RA administration by emergency physicians (EPs) is large enough that the American College of Emergency Physicians (ACEP) released a policy statement strongly supporting the use of ultrasound-guided RA (UGRA) in the ED. ![]() The safety and efficacy of RA for pain management is well established in anesthesia literature, and now, due to multiple research endeavors on this topic over the last decade, similar evidence exists regarding regional nerve block safety and efficacy when administered by trained providers in an ED setting. Through efforts by the emergency medicine (EM) community to find safe, effective, non-opioid treatments for pain, regional anesthesia (RA) emerged as a feasible option. While opioid medications were previously the mainstay of acute and chronic pain therapy for emergency department (ED) patients, overwhelming evidence demonstrates these drugs possess deleterious long- and short-term side effects as well as abuse potential, making them less than desirable therapeutic options in many situations. OL9363699W Page_number_confidence 43.82 Pages 218 Partner Innodata Pdf_module_version 0.0.19 Ppi 300 Rcs_key 24143 Republisher_date 20200902190128 Republisher_operator Republisher_time 259 Scandate 20200827220813 Scanner Scanningcenter cebu Scribe3_search_catalog isbn Scribe3_search_id 9780443050541 Tts_version 4.Effective and prompt treatment of pain is an important aspect of providing quality emergency care. Urn:lcp:essentialanatomy0000blac:epub:050eca14-85f3-433c-8178-a9fbc10f2c6e Foldoutcount 0 Grant_report Arcadia #4281 Identifier essentialanatomy0000blac Identifier-ark ark:/13960/t07x5jp55 Invoice 2089 Isbn 9780443050541Ġ443050546 Ocr tesseract 4.1.1 Ocr_detected_lang en Ocr_detected_lang_conf 1.0000 Ocr_detected_script Latin Ocr_module_version 0.0.5 Ocr_parameters -l eng Old_pallet IA17004 Openlibrary_edition Alastair Boxid IA1917917 Camera USB PTP Class Camera Collection_set printdisabled Donor Access-restricted-item true Addeddate 14:03:45 Associated-names Chambers, W. ![]()
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