Page 127 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures 125
Patient perspective
The median pain score on an NRS at baseline (t0) before UGRA was 8 (IQR 5–9). At 30 min (t30) after the nerve block, the median score was significantly reduced to 3 (IQR 2–5, p < .001). The pain was significantly reduced even further to 2 (IQR 0–4) at t60 and to 1 (IQR 0–1) at t120. Relative and absolute pain reductions are shown in Table 5.3 and Figure 5.1.
Patient-reported (dis)comfort was scored a median of 8 (IQR 8–9, n = 61). When asked if they were motivated to undergo a similar procedure in the future, the score was 9 (IQR 8–10, n = 60).
Pain reduction was not found to be significantly related to gender, age, fracture types, pre- hospital administration (and type) of analgesics, the two block types, the two different con- centrations of ropivacaine, or volume of injected LA. Also, we found no significant differ- ence in pain reduction at t30, t60, and t120, whether the EPs performed the blocks with or without supervision. As shown in Table 5.4.
EP perspective
The 1-day course was very well received, and the EPs were enthusiastic about starting to perform the nerve blocks after the course. The median scores, IQR in parentheses, of the self-reported qualifications of the procedure (n = 59) were ease of procedure 8 (7–9), success of procedure itself, regardless of the effect 9 (8–10), visibility of anatomical structures on ultrasound 8 (7–9), spread of local anesthetic 9 (8–10), and subjective added value of the procedure to patient care 9 (8–10).
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