Ultrasound-guided Ulnar Nerve Block Research Articles

POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE

BackgroundUltrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures (“boxer's fractures"). Case ReportA 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.

Ultrasound-guided peripheral forearm nerve block for digit fractures in a pediatric emergency department

Although ultrasound-guided peripheral nerve block (UGPNB) has recently been introduced into pediatric emergency departments (EDs), knowledge of its use is still limited among pediatric emergency physicians. Ultrasound-guided ulnar nerve block (UGUNB) is a form of peripheral nerve block available for controlling the pain caused by phalangeal injuries, but studies of its use in pediatric patients are still scarce. The aim of this case series was to describe the experience of UGUNB use for pediatric phalangeal fractures in a pediatric ED setting. In all the patients with phalangeal fractures, the ulnar nerve was successfully visualized using a hockey-stick type transducer. Approximately 0.1–0.2 mg/kg of 1% lidocaine was used as the nerve block. The procedure was effective for pain control, and fracture reduction was successfully performed without the need for rescue analgesia. This case series demonstrated that UGUNB has the potential to be a useful alternative to conventional pain management in pediatric fifth digit injuries.

Management of an Acute Exacerbation of Chronic Neuropathic Pain in the Emergency Department: A Case to Support Ultrasound-Guided Forearm Nerve Blocks

BackgroundAcute on chronic neuropathic pain is often refractory to analgesics and can be challenging to treat in the emergency department (ED). In addition, systemic medications such as opiates and nonsteroidal inflammatory drugs have risks, including hypotension and kidney injury, respectively. Difficulties in managing pain in patients with neuropathy can lead to prolonged ED stays, undesired admissions, and subsequent increased health care costs. Case ReportWe describe the case of a 51-year-old woman who presented to the ED on two separate occasions for left forearm pain secondary to chronic ulnar neuropathy. During her first ED visit, the patient received multiple rounds of intravenous opiates and required hospital admission, which was complicated by opiate-induced hypotension. During her second visit, she underwent an ultrasound-guided ulnar nerve block performed by the emergency physician; her pain resolved and she was discharged home. Why Should Emergency Physicians Be Aware of This?Ultrasound-guided nerve blocks are an effective, safe, and relatively inexpensive alternative to opioids. Our case demonstrates that emergency providers may be able to perform ultrasound-guided regional anesthesia to treat an acute exacerbation of chronic neuropathic pain.

Dexmedetomidine as an Adjuvant to Ropivacaine Prolongs Peripheral Nerve Block

Background. Dexmedetomidine is an a-2-receptor agonist which might be used as an additive to local anaesthetics for various regional anaesthetic techniques. We therefore designed this prospective, double-blinded, controlled volunteer study to investigate the effects of dexmedetomidine as an adjuvant to ropivacaine on peripheral nerve block. Methods. Ultrasound-guided ulnar nerve block (UNB) was performed in 36 volunteers with either 3 ml ropivacaine 0.75% (R), 3 ml ropivacaine 0.75% plus 20 mg dexmedetomidine (RpD), or 3 ml ropivacaine 0.75% plus systemic 20 mg dexmedetomidine (RsD). UNBrelated sensory and motor scores were evaluated. Results. Sensory onset time of UNB was not different between the study groups, whereas motor onset time was significantly faster in Group RpD when compared with the other study groups [mean (SD)] [21 (15) vs 43 (25) min in Group RsD and 47 (36) min in Group R, P,0.05 Group RpD vs other groups]. The duration of sensory block was 350 (54) min in Group R, 555 (118) min in Group RpD, and 395 (40) min in Group RsD (P,0.01 Group RpD vs other groups, P,0.05 Group RsD vs Group R). Motor block duration was similar to the duration of sensory block. Conclusions. A profound prolongation of UNB of � 60% was detected with perineural dexmedetomidine when added to 0.75% ropivacaine. The systemic administration of 20 mg dexmedetomidine resulted in a prolongation of � 10% during UNB with 0.75% ropivacaine. Eudra-CT No.: 2012-000030-19.

Ultrasound-Guided Ulnar Nerve Block in the Presence of a Superficial Ulnar Artery

Ultrasound-Guided Ulnar Nerve Block in the Presence of a Superficial Ulnar Artery