Application of Nerve Blocks in Upper and Lower Extremity Trauma Patients Presenting to the Emergency Department of a Tertiary Care Hospital: A Prospective Observational Study.

Abstract

Background Pain related to trauma is often severe and undergoes undertreated in many patients. Peripheral nerve blocks provide analgesia, which is site-specific and devoid of any systemic adverse effects. Regional anesthesia may also confer several other advantages including decreased length of stay in the emergency departmentand improved comfort and safety for emergency procedures compared to conventional analgesia. This study aims to evaluate the feasibility of the application of nerve blocks in upper and lower extremity trauma patients presenting to the Emergency Department of a tertiary care hospital. Methodology We conducted a prospective observational study in the Department of Emergency Medicine (EM) at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune between 2023 and 2024. As a part of this research proposal, we intended to study the application of nerve blocks in upper and lower extremity trauma among patients presenting with upper and lower extremity trauma to the ED during the study period. After institutional Ethics Committee approval and informed written consent, 95 patients aged above 18 years presenting with upper and lower extremity trauma within 12 hours were selected. Patients under 18 years old, those with a history of coagulopathies, patients with open fractures, and pregnant patients were excluded from the study. Results The study comprised 95 participants, with diverse age groups represented. Among them, 26% were under 25 years old, 54% fell between the ages of 26 and 30, and 20% were over 30 years old. Gender distribution showed 64.2% male and 35.8% female participants. In terms of injury nature, the majority experienced injuries from motor vehicle crashes (31.5%) and domestic incidents (22.1%), followed by workplace injuries (15.8%), sports injuries (14.7%), falls from heights (7.4%), and assault (7.4%). The time required for interventions varied, with 41.1% of cases completed in five minutes or less, while in 58.9% of instances, more than five minutes were necessary. Similarly, the time taken for pain relief post-intervention was reported, with 66.3% experiencing relief within five minutes and 33.7% requiring more than five minutes. On initial presentation, the mean VAS score was 8.8 with an SD of 1.1, indicating high levels of pain. Following the block, there was a significant reduction in pain, with the mean VAS score dropping to 1.9 and an SD of 1.2. This change was statistically significant with a p-value of less than 0.001, indicating a substantial improvement in pain levels post-block administration. Regarding the duration of pain relief, a similar pattern emerged, with 77.8% reporting relief lasting three hours or less, and 22.2% experiencing relief for more than three hours. Conclusion In emergency situations, our research showed that peripheral nerve blocks are a very useful tool for treating pain from trauma to the upper and lower extremities. These blocks significantly reduce pain and have a long-lasting effect. Further research with larger, multi-center trials is needed to validate these findings and explore long-term outcomes.