An Evaluation of Trainee-Executed Ultrasound-Guided Nerve Blocks in the Emergency Department

Background/Objectives: Peripheral nerve blocks offer the option of targeted pain relief localized to the injured areas while minimizing potential systemic side effects of opioids such as hypotension and respiratory depression. However, there is often hesitancy in the acute setting to perform these procedures. The objective of this study was to describe the technical performance and recorded complications of archived ultrasound-guided and ultrasound-assisted peripheral nerve blocks performed by Emergency Medicine trainees in the emergency department (ED). Methods: A retrospective review of patients presenting at two urban academic EDs who underwent ultrasound-guided peripheral nerve blocks. Data were collected from the ED ultrasound image archiving system and electronic medical record and included age, gender, level of provider training, and ultrasound image data. The primary outcome was technical performance, including needle-tip visualization and visualization of anesthetic infiltration. Secondary outcomes included recorded complications and technical outcomes by level of trainee experience. Results: A total of 72 patients were included in the final analysis. Ulnar nerve blocks were the most common procedure performed at 33%. No major complications were documented in the available records; one patient had documented paresthesia. On ultrasound image review, the needle tip was clearly visualized in 47/72 (65%) of blocks and infiltration of anesthetic was seen in real time in 79% of subjects. Conclusions: Among archived trainee-performed ultrasound-guided peripheral nerve blocks, needle-tip visualization and anesthetic-infiltration visualization varied across procedures and levels of training, and few complications were recorded. These findings provide descriptive data regarding the technical performance of trainee-performed ultrasound-guided nerve blocks but should not be interpreted as establishing their overall safety or clinical effectiveness.