scholarly journals Ultrasound-guided greater auricular nerve block as sole anesthetic for ear surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Michael K. Ritchie ◽  
Colin A. Wilson ◽  
Brian W. Grose ◽  
Pavithra Ranganathan ◽  
Stephen M. Howell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Operating Room ◽  
Nerve Block ◽  
Mastoid Process ◽  
Care Providers ◽  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Ear Surgery ◽  
Facial Surgery ◽  
Ultrasound Technology

A greater auricular nerve (GAN) block was used as the sole anesthetic for facial surgery in an 80 year-old male patient with multiple comorbidities which would have made general anesthesia challenging. The GAN provides sensation to the ear, mastoid process, parotid gland, and angle of the mandible. In addition to anesthesia for operating room surgery, the GAN block can be used for outpatient or emergency department procedures without the need for a separate anesthesia team. Although this nerve block has been performed using landmark based techniques, the ultrasound guided version offers several potential advantages. These advantages include increased reliability of the nerve block, as well as prevention of inadvertent vascular puncture or blockade of the phrenic nerve, brachial plexus, or deep cervical plexus. The increasing access to ultrasound technology for medical care providers outside the operating room makes this ultrasound guided block an increasingly viable alternative.

scholarly journals Ultrasound-guided removal of hypopharyngeal foreign body in the emergency department

Ultrasound ◽  
2017 ◽  
Vol 25 (4) ◽  
pp. 245-247
Author(s):  
Nadia Maria Shaukat ◽  
Alexis Lenz ◽  
Poonam Desai
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Operating Room ◽  
Ultrasound Guided ◽  
Partial Denture ◽  
Life Threatening ◽  
Foreign Body Impaction

Foreign body impaction at the cricopharyngeal level can be a life-threatening emergency. While traditionally, removal of these is performed in the operating room setting, patients with relatively unstable airways or significant discomfort may require immediate extraction to prevent further injury. This is the case of an 85-year-old man who presented to the emergency department in significant discomfort following aspiration of a large partial denture. We report here the first known use of ultrasound in an emergent airway situation to rapidly localize and retrieve an aspirated foreign body.

scholarly journals Evaluation of Efficacy of Femoral Nerve Block on Pain and Anxiety in Acute Fractures of the Femur in the Emergency Department

2021 ◽  
Author(s):  
Shiv Shanker Tripathi ◽  
Suruchi Ambasta ◽  
Swagat Mahapatra ◽  
Anurag Agarwal ◽  
Shivani Rastogi
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Nerve Block ◽  
Distal Femur ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Vas Score ◽  
The Mean ◽  
Fractures Of The Femur

Introduction: Fractures around the hip and fractures of the femur are commonly encountered in the Emergency Department (ED). Effective control of pain in these fractures is of critical importance for proper radiography, reduction and splintage. Traditionally, systemic analgesics have been used for pain relief which had its own limitations both in terms of pain relief and relaxation. Use of Femoral Nerve Block (FNB) in acute fractures around the hip and femur has been a challenge and, evaluation of this procedure has been the subject of research recently in ED. Aim: To evaluate the efficacy of FNB in decreasing pain and anxiety in acute fractures of the femur. Materials and Methods: Prospective interventional study was conducted at a tertiary care centre with well-defined inclusion and exclusion criteria. Eighty four patients with fractures around the hip, fractures of the shaft and distal femur underwent ultrasound guided FNB for performance of retrieval procedures. Visual analog scale (VAS) score for pain and Hamilton Anxiety Score (HAM-A) score for anxiety were used as parameter both for pre and postblock to assess the effectiveness. Subjective assessment of the patients comfort level was also done. Statistical analysis of all data obtained was done using SPSS 21.0. Results: Study group (n=84) included in the evaluation were homogenous in terms of age and sex distribution. The mean±SD VAS score preoperatively was 72.93±10.91. At 30 minutes and 4 hours postblock,the mean±SD VAS scores were 18.65±5.25 and 13.88±6.05, respectively. There was statistically significant difference in VAS score at 30 minutes (p=0.004) and 4 hours (p=0.015). The mean Hamilton Anxiety score at preblock and 4 hour postblock was 27.05±5.94 and 8.07±3.7, respectively. The overall HAM-A score comparison showed that there was statistically significant change after 4 hours postblock (p=0.013) showing significant decrease in anxiety levels. All patients were satisfied by the comfort and ease of shifting after block. Intergroup analysis of fractures around the hip (Neck femur, Trochanter) and fractures of the shaft (Shaft femur and distal femur) revealed equal efficacy of the femoral block. Conclusion: Ultrasound guided FNB is an easy and safe means of providing pain and anxiety relief to patients with the fracture of the femur (neck femur, per-trochanteric femur, shaft femur or distal femur) in the ED. At the same time, it decreases the need of systemic analgesia.

scholarly journals MP024: Ultrasound-guided femoral nerve block versus fascia iliaca block for hip fractures in the emergency department: a randomized pilot study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S74-S74
Author(s):  
J. Chenkin ◽  
J.S. Lee ◽  
T. Bhandari ◽  
R. Simard
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Nerve Block ◽  
Hip Fractures ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Comfort Level ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Pain Scores

Introduction: Regional anesthesia has been shown to be an effective pain control strategy for patients presenting with hip fractures in the emergency department. There are two common methods for performing this block: the femoral nerve block (FNB) and the fascia iliaca compartment block (FICB). The objective of this pilot study is to determine whether one of these two ultrasound-guided block techniques provides superior analgesia to emergency department patients with hip fractures. Methods: Emergency physicians at a single institution were randomized to the FNB or FICB training groups. Participants completed a 2-hour practical workshop covering the technique, followed by a questionnaire to assess their comfort with the block. They were asked to perform their assigned nerve block on any patient in the ED presenting with a hip or femur fracture. Physician comfort level and patient pain scores using a visual analog scale (VAS) were recorded before and after the nerve block were recorded. Comparisons were performed using Student’s t-test and Fisher’s exact test. Results: A total of 20 physicians were enrolled in the study, 10 in the FNB group and 10 in the FICB group. There were no significant baseline differences between the groups with respect to ultrasound or nerve block experience. Following the training, 100% of participants in both the FNB group and FICB group felt comfortable performing the block. Nerve blocks were performed in 30/51 (58.8%) of eligible patients in the FNB group and 6/11 (54.5%) in the FICB group (p=1.0). On the 10-point VAS, pain scores decreased by a mean of 4.9 (SD 3.5) in the FNB group and 8.3 (SD 2.4) in the FICB group (p=0.056). In practice, physicians felt comfortable performing the FNB in 52.8% of cases, and the FICB in 85.7% of cases (p=0.21). Mean time to completion of the blocks was similar between the two groups (19 vs 18 mins, p=0.83). Conclusion: In this pilot study, we found a non-significant trend towards improved analgesia and higher physician comfort with the ultrasound-guided FICB compared with the FNB in patients with hip fractures. We found no differences in time to performing the blocks. These results require confirmation with a larger sample size.

Upper Limb Ultrasound Guided Regional Anesthesia

2016 ◽  
Author(s):  
Stuart A. Grant ◽  
David B Auyong
Keyword(s):  
Upper Extremity ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Upper Limb ◽  
Clinical Anatomy ◽  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Nerve Blocks ◽  
Risks And Benefits ◽  
Tools And Techniques

This chapter describes the clinical anatomy and outlines the tools and techniques needed to perform upper extremity ultrasound-guided nerve blocks. The nerve blocks above the clavicle described here include the interscalene, dorsal scapular, suprascapular, cervical plexus, and supraclavicular blocks. Nerve blocks below the clavicle described here include the infraclavicular and axillary blocks and distal blocks at the wrist and elbow. For each nerve block, the indications, risks, and benefits of the varying approaches are described in detail. The chapter includes step-by-step instructions with illustrations, including cadaver dissections, to allow the operator to perform clinically effective and safe ultrasound-guided upper extremity regional anesthesia. At the conclusion of each block description, a “Pearls” segment highlights important tips gained from our clinical experience. This chapter provides the practitioner with thorough instruction and knowledge allowing optimal delivery of regional anesthesia for any upper extremity surgery or trauma.

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