Local and Regional Anesthesia in the Emergency Room
Regional anesthesia is being increasingly adapted into emergency department practice as training and technological improvements (e.g., ultrasound) become more prevalent. The same precautions and considerations for patients receiving nerve blocks in the perioperative setting should be followed for patients in the emergency department.
Occasionally, specialized regional procedures, such as “hematoma blocks,” are used in emergency practice and are associated with rare but significant complications, for example, local anesthetic toxicity.
Accurate documentation relating to the block, good communication among the health care team, and a readily available and appropriately stocked block cart are essential for safe regional anesthesia in the emergency department. Administration of the block should be done as close to the time of injury as possible.
Choosing the appropriate local anesthetic can help avoid complications of prolonged block, premature block resolution, and systemic toxicity.
Intoxicated patients present various challenges to performance of regional anesthesia in an emergency setting; alternative or modified measures (e.g., sedation or delaying the block) may have to be undertaken if the patient is not deemed competent to tolerate a nerve block.
KeywordsEmergency medicine Hematoma blocks Documentation Intoxicated patients Sedation Consent
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