Page 131 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures 129
at baseline to 4 after four hours. In the group receiving standard care, the NRS was 8 initially and showed no improvement.17 Haines et al. described 20 ED ultrasound-guided FICBs per- formed by six EPs, fellows, and residents. They found a pain reduction from a mean NRS of 7.9 at baseline to 2.05 at 30 min and 1.30 at 120 min.22
We showed EPs and EPs in training can be taught to effectively and safely perform UGRA in the ED. In addition, they experienced the procedure to be relatively easy and successful, represented by the high EP-reported scores for success, easiness, visibility of the anatomy, and quality of LA spread. These findings implicate that (Dutch) EPs should consider the introduction of ultrasound-guided regional anesthesia in proximal femoral fracture patients in the ED to provide superior pain management as compared to conventional systemic anal- gesics. Such a program should preferably be introduced in cooperation with their colleagues from the anesthesiology department. Once a successful UGRA program for these patients is implemented, it can be extended to other indications in need of excellent pain management.
With this project, we followed the recommendation by Wu et al. that anesthesiologists with extensive experience in regional anesthesia should introduce these techniques into settings outside the operating room and in the early treatment phases of trauma patients to provide the benefits of regional anesthesia.23 Although in our institution, skilled anesthesiologists collaborated with EPs to successfully introduce UGRA in the ED, this approach might not be feasible in other comparable hospitals. EPs must connect with instructors with sufficient skills who are willing and able to invest their time and energy. Nevertheless, superior pain relief should be obtained in trauma patients as early as possible, preferably by the first— prehospital—care provider they encounter.24 If this journey cannot start at home, adequate pain relief needs to be taken care of by the first care provider they encounter in the hospital.
This study adds to the literature because we took a unique approach in the introduction and execution of these blocks on our ED through a productive collaboration between the two (ED and anesthesiology) departments.
Furthermore, to date, there have been no published reports of effective and safe UGRA in a Dutch ED.
Limitations
This study has several limitations. The observational study design is not optimal to answer the main question. A relatively small number of patients was included based on convenience sampling. The aim was to treat proximal femoral fracture patients with ultrasound-guided nerve blocks as the treatment of choice. Although UGRA was recently introduced in our
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