Use of regional anesthesia is becoming more prevalent in the emergency department as more data emerge about its safety, efficacy, and, in many cases, associated decreased length of stay. Procedural sedation requires intravenous access, dedicated personnel for both the sedation and procedure, and a room within the emergency department equipped to provide airway management and resuscitation in the event of complications from IV anesthesia. Complications include hypoventilation/apnea, aspiration, laryngospasm, and hypotension. Often, the required painful procedure is brief, but the discomfort associated with the illness is long-lasting; procedural sedation provides anesthesia for a brief period of time, but does not control pain after the sedation is over. Regional anesthesia provides pain relief lasting for hours, allowing intervention in the patient’s acute illness without subjecting him or her to the risks of sedation. For patients whose injuries require transfer to a center with broader expertise, regional anesthesia can provide critical pain control without a change in respiratory pattern or mental status that could become dangerous during transit.
In the emergency department, ultrasound-guided brachial plexus block can provide rapid and definitive pain relief from traumatic injuries to the upper extremity. Emergency physicians have published data on using two approaches (interscalene and supraclavicular) for the ultrasound-guided brachial plexus block.1,2 Either can be used as a primary or supplementary method to provide analgesia for traumatic injuries and infections, including humeral fractures, upper-extremity joint reduction, abscess drainage, and burns. The interscalene and supraclavicular brachial plexus blocks are considered ultrasound-guided procedures with intermediate difficulty. However, the interscalene approach allows for identification of the brachial plexus while maintaining a greater distance from vascular structures and pleura than the supraclavicular approach. A simplified method to locate and perform the block will allow for integration of this useful procedure into the practice of emergency medicine. Both blocks are performed with ultrasound guidance in the emergency department setting. While anesthesiologists may use nerve stimulators to achieve these blocks, this technique is not typically employed in the emergency department. Moreover, there is evidence suggesting that ultrasound provides superior efficacy, compared with nerve stimulator block of the brachial plexus at the interscalene level.3