Regional Anesthesia in the Pediatric Emergency Department

Suprascapular nerve peripheral nerve stimulation for malignancy-related pain: A case series

Background

Blockade of the suprascapular nerve is an effective diagnostic tool in the workup and potential treatment of shoulder pain. For chronic shoulder pain, peripheral nerve stimulation has been shown to provide significant, sustained pain relief. However, no literature to date has described peripheral nerve stimulation for the treatment of oncologic shoulder pain.

Objectives

We describe two cases of chronic oncologic-related shoulder pain that responded to posterior suprascapular peripheral nerve stimulator placement to facilitate future progress and discussion in the fields of peripheral nerve stimulation and oncology pain.

Methods

Two subjects with chronic shoulder pain underwent ultrasound-guided peripheral nerve stimulation therapy at the suprascapular nerve.

Results

At follow-up visits (30 and 98 days after procedure), both subjects reported greater than 50% pain relief as measured by the numerical rating scale (NRS).

Conclusions

Peripheral nerve stimulator placement at the suprascapular nerve is a feasible procedure to treat oncologic shoulder pain via the described technique. Both subjects experienced clinically significant pain relief and decreased oral analgesic medication intake, and decreased medication-related side effects. This warrants further investigation including large comparative, prospective studies to better assess efficacy and safety of this approach.

Ultrasound-Guided Paravenous Saphenous Nerve Block for Lower Extremity Abscess Incision and Drainage in a Male Adolescent

ABSTRACT

The use of ultrasound-guided regional anesthesia is growing as a modality for analgesia provision within the pediatric emergency department. We present a case in which a paravenous saphenous nerve block was used for anesthesia during incision and drainage of a lower extremity abscess. We further review the technique and literature concerning this straightforward and effective procedure.

Trends of Regional Anesthesia Studies in Emergency Medicine: An Observational Study of Published Articles

Introduction: Regional anesthesia (RA) has become a prominent component of multimodal pain management in emergency medicine (EM), and its use has increased rapidly in recent decades. Nevertheless, there is a paucity of data on how RA practice has evolved in the specialty. In this study we sought to investigate how RA has been implemented in EM by analyzing trends of published articles and to describe the characteristics of the published research. Methods: We retrieved RA-related publications from the SciVerse Scopus database from inception to January 13, 2022, focusing on studies associated with the use of RA in EM. The primary outcome was an analysis of trend based on the number of annual publications. Other outcomes included reports of technique diversity by year, trends in the use of individual techniques, and characteristics of published articles. We used linear regression analysis to analyze trends. Results: In total, 133 eligible publications were included. We found that overall 23 techniques have been described and results published in the EM literature. Articles related to RA increased from one article in 1982 to 18 in 2021, and the rate of publication has increased more rapidly since 2016. Reports of lower extremity blocks (60.90%) were published most frequently in ranked-first aggregated citations. The use of thoracic nerve blocks, such as the erector spinae plane block, has increased exponentially in the past three years. The United States (41.35%) has published the most RA-related articles. Regional anesthesia administered by emergency physicians (52.63%) comprised the leading field in published articles related to RA. Most publications discussed single-shot (88.72%) and ultrasound-guided methods (55.64%). Conclusion: This study highlights that the number of published articles related to regional anesthesia in EM has increased. Although RA research has primarily focused on lower extremity blocks, clinical researchers continue to broaden the field of study to encompass a wide spectrum of techniques and indications.

Ultrasound-Guided Posterior Tibial Nerve Block for Plantar Foot Foreign Body Removal

Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and highly effective procedure.