背景:急性肩关节脱位是急诊(ED)常见的表现,然而,控制疼痛以促进这些患者的减少可能是具有挑战性的。虽然手术镇静和周围神经阻滞都可以提供有效的镇痛,两者也都有风险。具体来说,肌间沟臂丛神经阻滞可能会有同侧半膈神经麻痹的风险。有技术,然而,急诊临床医生可以利用这些风险来降低这些风险,并优化针对特定病理的肌间沟臂丛神经阻滞,例如肱骨脱位。
方法:我们报告了3例急性肱骨前脱位的ED患者。其中两名患者有肺部疾病史。在这三种情况下,我们进行了有针对性的小容量肌间沟神经阻滞,并联合全身镇痛,以促进成功的闭合性肱骨复位,并降低膈肌麻痹的风险.手术后对所有3例患者进行监测,并从ED出院。为什么紧急医生应该意识到这一点?:与通常寻求获得密集手术块的麻醉师相反,急诊临床医生的目标应该是为特定程序定制模块,病人,和病态。急诊临床医生可以通过使用针对特定神经根(C5和C6)的低容量(5-10mL)麻醉药来优化肌间沟臂丛神经阻滞治疗肱骨脱位,以提供有效的镇痛并减少dim肌受累的风险。
Acute glenohumeral dislocation is a common emergency department (ED) presentation, however, pain control to facilitate reduction in these patients can be challenging. Although both procedural sedation and peripheral nerve blocks can provide effective analgesia, both also carry risks. Specifically, the
interscalene brachial plexus block carries risk of ipsilateral hemidiaphragmatic paralysis due to inadvertent phrenic nerve involvement. There are techniques, however, that the emergency clinician can utilize to reduce these risks and optimize the
interscalene brachial plexus block for specific pathologies such as glenohumeral dislocation.
We report three cases of patients who presented to the ED with acute anterior glenohumeral dislocation. Two of the patients had a history of pulmonary disease. In all three cases, targeted low-volume
interscalene nerve blocks were performed and combined with systemic analgesia to facilitate successful closed glenohumeral reduction and reduce the risk of diaphragm paralysis. All 3 patients were monitored after the procedure and discharged from the ED. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Contrary to anesthesiologists who often seek to obtain dense surgical blocks, the goal of the emergency clinician should be to tailor blocks for specific procedures, patients, and pathologies. The emergency clinician can optimize the
interscalene brachial plexus block for glenohumeral dislocation by using a low volume (5-10 mL) of anesthetic targeted to specific nerve roots (C5 and C6) to provide effective analgesia and reduce the risk diaphragm involvement.