153 Feasibility of Ultrasonography-Guided Regional Nerve Blocks for Pain Management in Low-resource Settings

Abstract

Background: Ultrasonography-guided regional nerve block (USRNB) is a safe and simple analgesia tool that can be used to provide site-specific, rapid pain relief for bone and soft tissue injuries. USRNBs have many benefits over local anesthetic infiltration and avoid the complications associated with general anesthesia and other systemic drugs. Despite these advantages, USRNBs have not been widely used in limited resource settings, where up to 80% of injured persons receive inadequate or no pain treatment, and where bone and soft tissue injuries are a major cause of morbidity and mortality. The purpose of this study is to determine the feasibility of an USRNB approach to pain management in a low-resource area. To our knowledge, no published studies have investigated the feasibility or impact of teaching this technique to care providers in low-resource emergency and acute care settings. Methods: Participants included 8 physicians and orthopedic officers from the Health Education Action Leadership (HEAL) Africa Hospital in Goma, Eastern Democratic Republic of Congo. The course included 4 didactic sessions, each with lecture, procedure simulation, live model scanning and clinical scanning with course faculty. Two portable ultrasonographys, a Sonosite MTurbo and 180 model (Sonosite, Bothell, WA) were used in sessions on forearm, femoral and popliteal blocks. Gel models were loaned from Blue Phantom (Redmond, WA). Post-training evaluation measured participant satisfaction with training and participant ability to successfully perform USRNBs. A data sheet was completed for each block performed in post-training clinical practice and recorded indications for each type of blocks; alternate analgesia strategy that would have been utilized had block not been available; and change in patients' self-reported pain level after block. Results: 7/8 course participants described themselves “Very satisfied” and 1 as “Satisfied” with the course. 6/8 recommended no changes to the balance of didactic and hands-on training. All were able to successfully perform blocks post-training. 204 USRNBs were completed (129 popliteal/54 femoral/21 forearm) on 155 patients during the one-month follow-up period. Indications included digit and limb amputations, wounds, fractures, tendon rupture, fasciotomy, gunshot wounds, and dressing changes. 39% (61/155) patients would otherwise have received no analgesia for pain (narcotics are rarely available), 9% (14/155) would have received local anesthetic, and 49% (76/155) would have received general anesthesia/epidural. The average change in patients' reported pain-score was 7.4 on a 0-10 scale. Conclusions/Implications: Physicians and orthopedic officers were able to successfully complete USRNBs after a short training course and reported good satisfaction with their training. Patients reported dramatic reductions in pain level with USRNB. USRNB may be a feasible and effective method of emergent pain relief in a low-resource setting.