PDF(Pubmed)
Abstract：
Pain is a common reason that patients seek care in the emergency department (ED). Regional anaesthesia in the form of nerve blocks provides an excellent alternative to traditional forms of analgesia, and may be superior in managing musculoskeletal pain compared to opioids. Adequate pain management improves patient satisfaction, facilitates examination and minor procedures, and allows for earlier and safe discharge. In low resource settings this modality is underutilised due to lack of trained providers and/or support from specialised services, shortages of equipment, and lack of context-sensitive guidelines. Advances in ultrasound guided regional anaesthesia has the potential to improve access to safe and reliable anaesthesia. It is often not accessible or an active part of training even for emergency physicians. There are, however, a number of nerve blocks that are easy to learn, don\'t require specialised equipment, and can be readily applied in EDs for minor procedures and longer acting forms of analgesia. Nerve blocks more applicable in the operating theatre or best done under ultrasound guidance are mentioned but not discussed in this article. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to more commonly used types of regional anaesthesia in district level services. We discuss the importance of good clinical practice including thorough preparation of equipment and the patient to avoid common complications, clinical indications for regional blocks in the ED, local anaesthetic agents, different techniques for some common regional blocks, potential complications, and the need for a trained interprofessional team.
摘要：
疼痛是患者在急诊科（ED）寻求护理的常见原因。神经阻滞形式的区域麻醉为传统形式的镇痛提供了极好的替代方案，与阿片类药物相比，在管理肌肉骨骼疼痛方面可能更好。适当的疼痛管理可提高患者满意度，方便考试和次要程序，并允许更早和安全的排放。在低资源环境中，由于缺乏训练有素的提供者和/或专业服务的支持，这种方式未得到充分利用。设备短缺,缺乏上下文相关的指导方针。超声引导区域麻醉的进展有可能改善获得安全可靠的麻醉。即使对于急诊医生来说，它通常也是无法获得或培训的积极部分。有,然而,许多易于学习的神经阻滞，不需要专门的设备，并且可以很容易地应用于ED的次要程序和更长效的镇痛形式。提到了更适用于手术室或最好在超声引导下进行的神经阻滞，但本文未讨论。这篇持续专业发展（CPD）文章旨在就与地区级服务中更常用的区域麻醉类型相关的几个关键领域提供指导。我们讨论了良好临床实践的重要性，包括彻底准备设备和患者，以避免常见的并发症，ED区域阻滞的临床指征，局部麻醉剂，一些常见的区域区块的不同技术，潜在的并发症,以及需要一支训练有素的跨专业团队。
