Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies

Michael B Stone, Ralph Wang, Daniel D Price
American Journal of Emergency Medicine 2008, 26 (6): 706-10

BACKGROUND: Emergency physicians often treat patients who require procedural sedation for the management of upper extremity fractures, dislocations, and abscesses (upper extremity emergencies). Unfortunately, procedural sedation is associated with several rare but potentially serious adverse effects and requires continuous hemodynamic monitoring and several dedicated staff members. The purpose of this study was to determine the role of ultrasound-guided supraclavicular brachial plexus nerve blocks in the emergency department (ED) as an alternative to procedural sedation for the management of upper extremity emergencies.

METHODS: In a prospective trial, a convenience sample of ED patients with upper extremity emergencies that would normally require procedural sedation were assigned to receive either procedural sedation or an ultrasound-guided supraclavicular brachial plexus nerve block. Emergency department length of stay (ED LOS) was the primary outcome measure and was analyzed using a paired 2-tailed Student t test.

RESULTS: A total of 12 subjects were enrolled. Average ED LOS for subjects receiving the brachial plexus nerve block was 106 minutes (95% confidence interval, 57-155 minutes). Average ED LOS for subjects receiving procedural sedation was 285 minutes (95% confidence interval, 228-343 minutes). The ED LOS was significantly shorter in the nerve block group (P < .0005). Patient satisfaction was high in both groups, and no significant complications occurred in either group.

CONCLUSIONS: In our population, ultrasound-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses.

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