How to Implement Ultrasound-Guided Nerve Blocks in Your ED

Figure 3. For higher-volume blocks (more than 10 cc), we recommend a two-operator technique. The operator is using an in-plane technique to perform a distal sciatic nerve block in the popliteal fossa. A) NS flush is attached to the IV tubing and block needle. Fluid is flushed to remove air from the circuit. B) After scanning the area and placing a skin wheal (with the insulin or TB syringe), hydrodissect the tissue with NS gently until the needle tip is in the ideal location for anesthetic placement. Remove the NS flush and attach the 10-cc syringe of local anesthetic. Inject slowly (aspirating after every 1–2 cc to ensure lack of vascular puncture) with clear needle tip visualization.

Conclusion

Putting systems in place that allow clinicians to optimize clinical care is crucial to maintaining best practices and efficient flow in the emergency department. Simple design solutions reduce barriers, increase compliance, and ideally improve patient care. Our simple block bag, which is composed of common items found in most emergency departments, may increase the number of UGNBs performed in your department. With more emergency departments attempting to reduce overreliance on opioids for acute pain management, this design innovation can aid in facilitating the integration of UGNBs into clinical care.

Dr. Nagdev is director of emergency ultrasound at Highland General Hospital in Oakland, California.

Dr. Brant-Zawadzki is a fellow in wilderness medicine at the University of Utah in Salt Lake City.

Dr. Herring is associate director of research at Highland General Hospital.