Abstract
Background: In Emergency Departments EDs , procedural sedation analgesia, hematoma block, intravenous regional anaesthesia and peripheral nerve blocks are usually used for pain control in forearm fractures. We aimed to review the results of Visual Analog Scale VAS scores during examination and reduction , post reduction neurovascular examinations and complications of forearm fractures which were applied US-guided axillary approach of brachial plexus block AABPB . Patients and Methods: We described fourteen patients, who presented to the ED with forearm fractures, and were reduced using US-guided AABPB performed by emergency physicians. The same technique was used for all fourteen nerve blocks. We reviewed the results of VAS scores during examination and reduction , post reduction neurovascular examinations and complications of forearm fractures who were applied AABPB. Results: Of the 14 patients admitted to study, the mean age was 59.92 ±12,81 36.00 – 82.00 . Mean VAS score of patients before procedures was 91.57 ± 3.99 85,00 – 98.00 mm. The US-guided AABPB was performed by emergency physicians and nerve block fracture was reduced. 20 minutes after reduction, mean VAS score of patients was 10.21 ± 5.36 0 – 19.00 mm. performed Table 1 . All patients were discharged after approximately eight hours’ observation period and post-reduction neurovascular examinations were normal. There were no complications during block and reduction. Conclusion: US-guided axillary approach of brachial plexus block is a technique that can be applied easily in the ED by emergency physicians for forearm fractures. In this technique, the procedural success rate is high, and it was noticed a high level of patient and physician satisfaction.
Keywords
References
- Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (New York, NY). 2012;7:18-22. [CrossRef]
- Kuyucu E, Kocyigit F, Ciftci L. The importance of patient compliance in nonunion of forearm fracture. International journal of surgery case reports. 2014;5:598-600. [CrossRef]
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. The Journal of hand surgery. 2001;26:908-15. [CrossRef]
- Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Annals of emergency medicine. 2014;63:247-58.e18. [CrossRef]
- Ünlüer Erol Erden KA, Ünlüer Seran, Koşargelir Mehmet, Kızılkaya Mehmet, Alimoğlu Orhan, Akoğlu Haldun et al. Ultrasound Guided Supracondylar Radial Nerve Block for Colles Fractures in the Emergency Department. American Journal of Emergency Medicine. (2016). [CrossRef]
- Alimohammadi H, Azizi MR, Safari S, Amini A, Kariman H, Hatamabadi HR. Axillary nerve block in comparison with intravenous midazolam/ fentanyl for painless reduction of upper extremity fractures. Acta medica Iranica. 2014;52:122-4.
- Reichman EF. Local Anesthesia. In: Reichman EF. eds. Emergency Medicine Procedures eNY, NY: McGraw-Hill; 2013: 803-4.
- Alimohammadi H, Shojaee M, Samiei M, Abyari S, Vafaee A, Mirkheshti A. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial. Emergency (Tehran, Iran). 2013;1:11-4.
- McLeskey CH. Rational use of local anesthetic drugs. North Carolina medical journal. 1982;43:496-500.
- Ganong WF, Excitable tissue: nerve iGWRoM, 18th ed. 1997:47–59.
- Ecoffey C, Oger E, Marchand-Maillet F, Cimino Y, Rannou JJ, Beloeil H. Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres. European journal of anaesthesiology. 2014;31:606-10. [CrossRef]
Abstract
Amaç: Acil Servislerde, ön kol kırıklarında ağrı kontrolü için genelde prosedürel sedasyon analjezi, hematom bloğu, intravenöz rejyonel anestezi ve periferal sinir blokları kullanılmaktadır. Ön kol kırıklarında, USG eşliğinde aksiller yaklaşımlı brakial pleksus bloğu AABPB uygulanan kişilerde, vizüel ağrı skalasını muayene sırasında ve redüksiyonda , redüksiyon sonrasındaki nörovasküler muayene ve komplikasyonları gözden geçirmeyi hedefledik. Hastalar ve Yöntem: Acil Servise ön kol kırığı ile başvuran ve acil hekimleri tarafından USG eşliğinde AABPB uygulanarak redükte edilen 14 hasta tarif edildi. 14 hastaya da aynı teknik uygulandı. Ön kol kırığında AABPB uygulananların, VAS skorlarını muayene sırasında ve redüksiyon esnasında , redüksiyon sonrası nörovasküler muayenelerini ve komplikasyonlarını gözden geçirdik Bulgular: Çalışmaya 14 hasta dahil edildi ve hastaların ortalama yaşları 59.92 ±12,81 36.00 – 82.00 idi. Ortalama VAS skorları prosedür öncesi 91.57 ± 3.99 85,00 – 98.00 mm. idi. USG eşliğinde AABPB acil servis hekimi tarafından uygulandı ve blok sonrasında kırık redükte edildi. Hastaların 20 dakika sonrasındaki redüksiyon sırasındaki VAS skorları 10.21 ± 5.36 0 – 19.00 mm. idi. Tüm hastaların yaklaşık sekiz saat gözlem sonrasındaki redüksiyon sonrası nörovasküler muayeneleri normaldi. Redüksiyon ve blok esnasında herhangi bir komplikasyon bildirilmedi. Sonuç: USG eşliğinde AABPB, ön kol kırıklarında acil servis hekimleri tarafından acil serviste kolayca uygulanabilir bir tekniktir. Bu teknikte, prosedür başarı oranı yüksek ve hasta ve hekim memnuniyetinin yüksek düzeyde olduğunu fark ettik.
Keywords
References
- Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (New York, NY). 2012;7:18-22. [CrossRef]
- Kuyucu E, Kocyigit F, Ciftci L. The importance of patient compliance in nonunion of forearm fracture. International journal of surgery case reports. 2014;5:598-600. [CrossRef]
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. The Journal of hand surgery. 2001;26:908-15. [CrossRef]
- Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, et al. Clinical policy: procedural sedation and analgesia in the emergency department. Annals of emergency medicine. 2014;63:247-58.e18. [CrossRef]
- Ünlüer Erol Erden KA, Ünlüer Seran, Koşargelir Mehmet, Kızılkaya Mehmet, Alimoğlu Orhan, Akoğlu Haldun et al. Ultrasound Guided Supracondylar Radial Nerve Block for Colles Fractures in the Emergency Department. American Journal of Emergency Medicine. (2016). [CrossRef]
- Alimohammadi H, Azizi MR, Safari S, Amini A, Kariman H, Hatamabadi HR. Axillary nerve block in comparison with intravenous midazolam/ fentanyl for painless reduction of upper extremity fractures. Acta medica Iranica. 2014;52:122-4.
- Reichman EF. Local Anesthesia. In: Reichman EF. eds. Emergency Medicine Procedures eNY, NY: McGraw-Hill; 2013: 803-4.
- Alimohammadi H, Shojaee M, Samiei M, Abyari S, Vafaee A, Mirkheshti A. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial. Emergency (Tehran, Iran). 2013;1:11-4.
- McLeskey CH. Rational use of local anesthetic drugs. North Carolina medical journal. 1982;43:496-500.
- Ganong WF, Excitable tissue: nerve iGWRoM, 18th ed. 1997:47–59.
- Ecoffey C, Oger E, Marchand-Maillet F, Cimino Y, Rannou JJ, Beloeil H. Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks: a web-based survey of 36 French centres. European journal of anaesthesiology. 2014;31:606-10. [CrossRef]
Details
| Primary Language | English |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 1, 2018 |
| Published in Issue | Year 2018Issue: 3 |