Ultrasound-guided nerve blocks (USGNBs) are gradually becoming an important skill set for the emergency physician and will soon be an expected core competency for emergency medicine (EM) residents. Understanding the importance of a multimodal strategy for acute pain control has become an imperative during the current opioid crisis, as well as an ideal method to provide optimal pain control to patients. Similar to other procedures that emergency physicians have learned and adapted from our anesthesia colleagues (endotracheal intubation, central venous cannulation, etc.), USGNBs have been integrated into clinical practice at various emergency departments (EDs). Academic emergency physician groups have published research detailing reduced reliance on opioids as well as improvements in patient pain scores and functional outcomes when USGNBs are performed in the ED.1 A recent large multicenter study demonstrated decreased mortality when USGNBs are used for patients who present with acute hip fractures.2 Additionally, integrating USGNBs as part of a multimodal pathway for acute pain management may decrease or even prevent the development of chronic pain.3
Explore This IssueACEP Now: Vol 42 – No 01 – January 2023
Some may argue that specialized academic EDs are the only place where USGNBs can be performed, but we believe the opposite. Smaller non-academic and/or non-trauma centers without specialty pain services are where many patients present with acute injuries; emergency physicians are often the only physicians available during off-hours with the procedural skills to perform USGNBs for optimal pain control. The development and integration of USGNBs into modern emergency care is imperative in reducing over-reliance on monomodal opioid-centered therapy and providing patients with optimal evidence-based care. We hope to describe a framework for EDs when developing an USGNB program that can be a part of a multimodal pain management pathway at various medical centers around the country (see Figure 1).
USGNB Champion Skill Development
Integration of new techniques in emergency care always requires a clinician champion to develop domain knowledge. This was seen with the ED implementation of diagnostic point-of-care ultrasound (POCUS), laryngoscopy, and more recently resuscitative transesophageal echocardiography (TEE). These self-appointed clinician leaders have several methods available to obtain the skills and knowledge that are required to be champions for USGNBs in their respective EDs.
The first and often easiest method that fosters interdepartmental collaboration is to learn from trained regional anesthesiologists at your respective center. Especially in smaller hospital systems where non-siloed partnerships are common, learning essential blocks and needling skills in the operating room (OR) or post anesthesia care unit (PACU) can be an easy option for education. This also allows the ED champion to determine the equipment, medications, and tools already used in their hospital for USGNBs and to integrate them into ED practice.