Given this memorial day weekend, and the sacrifice of our troops, lets discuss something that the military has used for years – and for good reason. US-guided nerve blocks are becoming more and more utilized in our EDs. Especially when we have the elderly patient who is in severe pain from a humeral fracture or a femoral neck fracture, and you’d rather not have to watch (and chase) their blood pressure after giving systemic opiates. It is also a great resource in resource-poor areas, like the aftermath of the disaster of the Haiti earthquake. This is all clearly discussed in the article in Annals of Emergency Medicine this month by Drs. Suzanne Lippert, Arun Nagdev, Mike Stone, Andrew Herring, and Robert Norris. Thanks to the hard work of many ED physicians including those above who promote a multi-disciplinary approach to the institution of US-guided nerve blocks which include Anesthesia, Ortho, Pediatrics, General/Trauma Surgery, and Nursing staff as well as consensus indications, contraindications, protocols for the transfer of care, and quality assurance programs which will all create a successful US guided nerve block program.
The main thing: DONT BE AFRAID TO DO IT! There is a specific checklist prior to performing one in the appropriate patient (for example: patient not altered, ability to perform a good/complete neuro exam, not an open fracture, no vascular injury or neuro deficits or signs of compartment syndrome of target extremity, patient is on cardiac monitor with IV access, informed consent obtained, intralipid is readily available in case of local anesthetic toxicity). Post-block care and the appropriate information exchange in the transfer of care are also key to a successful procedure. For specific training on each block, look over to your right on the blogroll to learn more – there are also tons of youtube videos to see the technique. Thanks to Dr. Suzanne Lippert for creating this cheat sheet (yes, I took a pic of it – not near high tech equipment today, and neither should you be on this memorial day :):