Feasibility and initial experience with continuous nerve blocks by emergency physicians

Abstract

IntroductionPeripheral nerve blocks and regional anesthesia are routinely used to alleviate pain in the emergency department. Our objective is to report on the feasibility and initial experience of emergency physicians initiating and managing continuous nerve blocks for trauma patients. MethodsThis was a retrospective, observational cohort study of a convenience sample of patients 18 years or older presenting with either rib or hip fractures between August 15, 2016 and January 15, 2019. Demographic and clinical data was abstracted using a structured data collection form. Data collected included basic demographics, mechanism of injury, type of regional anesthesia, admission location, respiratory complications, pre- and post-procedure opioid use, efficacy of anesthesia and duration of continuous nerve blockade. All analyses were descriptive in nature, including means, median, and range when appropriate. ResultsForty-one patients presented during the study period with rib or hip fractures and received a nerve block catheter and a continuous infusion pump. The mean age of patients was 65.9 years and 26 (63.4%) patients were male. The mean duration of continuous nerve blockade was 3.4 days (range 1–9 days). Hourly opioid use was reduced by 58%. The most common complication was accidental dislodgement of the catheter;, no patient developed a pneumothorax, hemothorax, catheter related infection, or hematoma. ConclusionsIt is feasible and effective for emergency physicians to initiate and manage continuous nerve blockade for acute hip and rib fractures. Continuous nerve blockade may allow trauma patients to significantly decrease their use of opioids.