Episode Summaries
BlockHeads aims to build a strong community of emergency medicine experts who share best practices and helpful tips for adopting ultrasound-guided regional analgesia in the emergency setting. To that end, we will regularly share summaries from our monthly Zoom meetings to highlight key points.
If you find these topics interesting and would like to get involved, we would love to have you join us at our next meeting!
Nerve Block Registry Update (1st)
In June of 2024, Blockheads, a group of nerve block enthusiasts in emergency medicine, met to discuss complications and review preliminary data from a multi-site registry for nerve blocks. Dr. Lachlan Driver presented data collected from January 2022 to December 2023, encompassing over 2,700 blocks performed across 11 national sites. The most common blocks were fascia iliaca, supraclavicular, and transversus abdominis plane blocks. Challenges recorded included patient movement, difficulty visualizing the needle tip, and anatomical variations.
Adverse events were rare and included three episodes of hoarseness, one episode of hyperventilation/anxiety/breathing difficulty, and three episodes of difficulty walking/sprained ankle/weakness. Notably, there were no instances of significant bleeding, arrhythmias, seizures, compartment syndromes, infections, or pneumothorax. One potential serious adverse event involved the use of intralipid due to possible local anesthetic systemic toxicity (LAST). The team emphasized the importance of early and liberal administration of intralipid in suspected LAST cases.
The discussion highlighted the challenges of data collection and the potential for underreporting delayed side effects. The group acknowledged the limitations of retrospective data collection and emphasized the need for standardized protocols and improved electronic medical record systems to enhance data quality.
Dr. Tomislav Jelic then discussed complications, focusing on nerve injury, infection, and bleeding. He emphasized the importance of minimizing infection risk through clean techniques and using ultrasound guidance to reduce the risk of peripheral nerve injury. Dr. Jelic also highlighted the significance of providing clear discharge instructions to patients, including education about rebound pain and the importance of limb protection.
The meeting concluded with a Q&A session, during which participants discussed the potential benefits and drawbacks of using dexamethasone to mitigate rebound pain and the importance of ongoing research to improve the safety and efficacy of nerve blocks in emergency medicine.