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Nerve Block App

The Nerve Block App makes regional anaesthesia easier on the go.

With POCUS use now an integral part of Emergency Medicine training, many practitioners have developed a core skillset in performing ultrasound-guided peripheral nerve blocks. Most of us will have started with the femoral nerve block and fascia iliaca compartment block, however these skills can be quickly translated to other regional blocks with appropriate education.

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  How to Implement Ultrasound-Guided Nerve Blocks in Your ED

In patients with contraindications to procedural sedation, UGNBs may also be the only suitable method for targeted analgesia.

Articles of Interest

Femoral

Although imperfect, I think these studies make it pretty clear that femoral nerve blocks will decrease pain and decrease opioid use. However, the decreases in pain are pretty modest, and a decrease in opioid use is really a surrogate outcome.

Foot

The appropriate site is approximately 1 cm superior to the medial malleolus and anterior to the achille's tendon.

Forearm

Forearm nerve blocks do not provide anesthesia to the volar surface of the forearm and wrist due to innervation of these regions by cutaneous nerves (i.e. musculocutaneous nerve)

Forearm - Pediatrics

The forearm nerve block is one of many blocks used in the ED for emergent pain control and procedural anesthesia. This block targets the median, radial, and ulnar nerves, and is effective in delivering anesthesia to the hand. The technique is highly effective in scenarios which have been traditionally challenging for pain control in the pediatric patient (burns to the hand, complex lacerations, fracture reduction and abscess incision and drainage).

Hand

Nerve blocks of the median, ulnar, radial, and digital nerves are useful for injuries of the hand including fractures, lacerations, and burns.

Occipital Nerve Block

An occipital nerve block is a peripheral nerve block performed on the greater and lesser occipital nerves to help treat headache. Occipital nerve block (ONB) has been used in the treatment of cervicogenic headache, cluster headache, and occipital neuralgia, with demonstrated efficacy in improving pain and reducing headache frequency

Peripheral

While there are various peripheral nerve blocks that are appropriate in the ED setting, there are three in particular that are further supported by evidence: Interscalene block, Regional nerve B\blocks of the hip, Nerve blocks for headache.

Hip Nerve Block Toolkit

Whether you are relocating joints, fishing glass out of heels, or providing analgesia for painful fractures, depending less on narcotics and procedural sedation can be good for patients and good for your department. A hip nerve block for a proximal femur fracture is the perfect example.

Ultrasound-Guided Nerve Blocks

Ultrasound-guided nerve blocks (UGNBs) are a vital part of the multimodal approach to the treatment of acute pain in the emergency department. The classic mono-modal approach, which has been the cornerstone of emergency medicine training, has been shown to produce inadvertent acute effects (hypotension, apnea, delirium, etc.) and chronic conditions (opioid addiction) as downstream consequences.

Ultrasound-guided nerve blocks in the emergency department

Many procedures commonly performed in the emergency department (ED) require regional anesthesia coupled with procedural sedation to achieve adequate patient comfort and cooperation. These procedures include: joint dislocation reduction, fracture reduction, and wound care. Providing field anesthesia with local injections becomes problematic, however, when dealing with large surface areas requiring a volume of medication that approaches toxic doses (e.g., a large laceration repair).

Ultrasound-Guided Pediatric Nerve Blocks in the Emergency Department

Nerve blocks are a powerful tool to help control pain and facilitate medical procedures for both adult and pediatric patients, but pediatric patients present unique challenges.

Resources

Block Buddy

Advance your regional anesthesia education with Block Buddy Pro!

Nerve Block

An easy-to-use, free, bedside app for nerve blocks.