Regional blocks in EM

[combatwombat]

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Do these get done much? From what I know of ultrasound guided blocks, it seems like they could be extremely useful in the ED. However I have not seen or even heard of a single one being done at either of the two EDs I've rotated through so far. Is the ultrasound-guided nerve block something I should try to learn if Im going into EM?

 

[dotcb]

US guided regional anesthesia is relatively new in EM. There are a few proponents, mostly ultrasound aficionados, but it just hasn't made its way into widespread clinical practice. There are many ways to accomplish a goal (reduction, lac repair, etc.), and not that difficult to get around ultrasound by either doing local infiltration, giving systemic analgesia, or even procedural sedation. Change occurs slowly in medicine. It will just take time.

 

[mauricekenter]

I love doing ankle blocks, wrist blocks (radial, ulnar, median) and the femoral nerve block. I don't do much else, even though you could do an axillary block for a lot of the hand and forearm stuff. My favorite is for sure the femoral nerve block (us guided) since little old ladies crack their femurs pretty regularly and it's nice to not need opiates.

Check out the ultrasound podcast on how to perform the femoral nerve block, pretty sweet resource.

I agree with the above poster. Definitely not mainstream, but definitely better for patient care if you do it right and get good at it.

 

[Zanegray]

I love doing ankle blocks, wrist blocks (radial, ulnar, median) and the femoral nerve block. I don't do much else, even though you could do an axillary block for a lot of the hand and forearm stuff. My favorite is for sure the femoral nerve block (us guided) since little old ladies crack their femurs pretty regularly and it's nice to not need opiates.

Check out the ultrasound podcast on how to perform the femoral nerve block, pretty sweet resource.

I agree with the above poster. Definitely not mainstream, but definitely better for patient care if you do it right and get good at it.

I think one reason many don't do this is that it takes time to learn. Anesthesiologists do a complete fellowship for this. Emergency medicine is broad and requires many skills, and I think we are somewhat limited by this. Beware complications of nerve blocks, they do exist, and it may open you up to litigation because it may be judged outside our scope based on the above.

That said... I love ultrasound, not trying to be a naysayer - if you are comfortable with it, great, and potentially a good tool, particularly in the elderly.

 

[WilcoWorld]

Some of these are bread and butter EM: Inferior alveolar block, digital block.
Some are on the "ought-a know" list, but aren't known by all: ankle, wrist, auricular & femoral blocks.
The rest are still "cutting edge", either because of technical difficulty, infrequency of need or simply because they take (or are thought to take) too much time for a busy doc to want to do.

 

[Doctor Bob]

The ones that I regularly use would be...

Inferior alveolar, auricular, supraorbital, infraorbital, mental, occipital, elbow, wrist, digital, rectal, femoral, popliteal, ankle/foot. There are lots of assorted local blocks like upper teeth, paraspinals, rib blocks, and so forth that I also do.

Lidocaine, properly placed, gives much better pain relief than opiates.