PROCEDURES

https://pubmed.ncbi.nlm.nih.gov/28460809/

9/23/2020

Reviewer: Dr. Warren Linnerooth

Summary: This study compares compares pain scores, patient satisfaction, complication rates, length of stay for ultrasound-guided interscalene nerve block vs procedural sedation via propofol/fentanyl for anterior shoulder dislocations.

Limitations: Both groups had few significant side effects during their stay in the ED. However, with limited sample size, only 30 patients in each group, and with no long term follow up, the study did not look at the incidence of rare, serious side effects, such as chronic pain from long thoracic nerve damage, dorsal scapular nerve damage. In the operating room, muscle stimulation/twitching is used to identify these structures, which is usually not utilized in the emergency department, which makes identification and avoidance of these structures via US all the more crucial. All of the ED physicians in this study had fairly good experience with US guided nerve blocks, at least 1 per week for 1 year.

Practice Changing? Yes

Take Home Point: The study found decreased length of stay for US guided interscalene block compared to procedural sedation for shoulder dislocation reduction (80.2 vs 108.6 minutes). Subjective pain and satisfaction scores were somewhat worse for for US guided interscalene block vs procedural sedation, although overall, US guided interscalene block was well-tolerated by patients with acceptable patient satisfaction.

12/24/2018

Reviewer: Dr. Tim Montrief

Article: https://www.sciencedirect.com/science/article/pii/S0735675714007190?via%3Dihub

Prospective, observational, single-center cohort study in a large tertiary academic center using a convenience sample of patients in the emergency department who had an above-the-diaphragm central venous catheter placed.

Limitations:

- Small sample size

- Single-site study performed at an academic institution with emergency medicine residents

- Study not powered to look for accuracy, but rather time to complete the study (POCUS vs CXR)

Practice changing? - It depends. In a certain patient population this could be a very useful application of POCUS. In particular, those critically ill patients requiring immediate use of a just-placed central venous catheter.

Take home point – A 2 point ultrasound protocol confirms central line placement and identifies complications more rapidly than standard portable CVXR in a select population of ED patients.