1887
  1. Home
  2. A-Z Publications
  3. Journal of Emergency Medicine, Trauma and Acute Care
  4. Volume 2023, Issue 2
  5. Article
Volume 2023, Issue 2
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Pain is the most common complaint in patients presenting to an emergency department (ED). Providing safe and effective pain management is an essential part and primary goal of initial ED management. It can be challenging, especially with a significant injury such as a humerus fracture or any long-bone injury. The movement of patients to get X-rays or transfer to a special bed can cause additional pain. Patients experiencing greater pain will more likely require extended hospital stays, be slower to mobilize, and experience a lower quality of life-related to their health.

1. This study aimed to compare the efficacy of ultrasound-guided supraclavicular brachial plexus block and intravenous tramadol in relieving pain in patients with isolated upper limb injuries who are presented to the ED. 2. To study the efficacy and safety of ultrasound-guided supraclavicular brachial plexus block for the management of pain caused due to upper limb injuries in ED.

A total of 40 patients with isolated upper extremity closed injuries (dislocations and fractures) who were presented to ED were investigated in this study. Eligible patients were asked to choose USG-guided SCB or intravenous tramadol treatment for pain management. For their initial analgesia, participants in Group A were given ultrasound-guided supraclavicular brachial plexus block, while Group B received 50 mg intravenous tramadol for over 10 min. After the treatment, patients were assessed for pain relief at 0 min, 15 min, 30 min, and 1 hour in both groups, and their vitals and pain score were recorded. The duration of pain relief, complication, and usage of rescue drugs was recorded, and the efficacy of both methods was compared. All patients were investigated with an X-ray or CT scan (if required) to confirm their diagnosis. Clinical information was recorded for 60 minutes, and patients were discharged or admitted.

Of the patients who were presented with upper extremity injuries, only 40 were enrolled in this study. USG-guided SCB was performed on Group A ( = 20) patients. Alternatively, Group B ( = 20) patients received intravenous tramadol 50 mg. In Group A, female patients were higher in number. In contrast, the opposite was noted in Group B. Road traffic accidents was considered the most common way of causing injury, and the most common injury was fractures. The shoulder was more commonly injured than the other parts. The mean pain score in Group A patients on arrival was 8.2, while that of Group B patients was 7.1. After the therapy, the mean pain score in Group A was drastically reduced to 2.9; in Group B, it was reduced to only 4.45. Further, the requirement for additional analgesics was higher in the tramadol group than in the ultrasound-guided supraclavicular block group. 23 out of 40 patients were admitted for further care and management.

In patients with upper limb injuries to the ED, ultrasound-guided supraclavicular block can provide better pain relief and be more efficacious than parenteral tramadol treatment.

© 2023 Choudhary, Nithyanand, Jain, Choudhary, licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2023.18
2023-07-05
2024-07-24
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2023/2/jemtac.2023.18.html?itemId=/content/journals/10.5339/jemtac.2023.18&mimeType=html&fmt=ahah

References

  1. Ducharme J. Emergency pain management: A Canadian Association of Emergency Physicians (CAEP) consensus document. J Emerg Med. 1994 Nov-Dec; 12:(6):855–66.
     [Google Scholar]
  2. Keene DD, Rea WE, Aldington D. Acute pain management in trauma. Trauma. 2011; 13:(3):167–179.
     [Google Scholar]
  3. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: Reciprocal neural, endocrine, and immune interactions. J Pain. 2008 Feb; 9:(2):122–45.
     [Google Scholar]
  4. Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med. 2008 Jul; 36:(7 Suppl):S346–57.
     [Google Scholar]
  5. Holbrook TL, Galarneau MR, Dye JL, Quinn K, Dougherty AL. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl J Med. 2010 Jan 14; 362:(2):110–7.
     [Google Scholar]
  6. Taherzadeh D, Jahanian F, Montazer H, Bozorgi F, Aminiahidashti H, Hosseininejad M, et al. A comparison of ultrasound-guided 3-in-1 femoral nerve block versus parenteral morphine sulfate for pain management in fractured femur in emergency department. J Clin Trials. 2015 May; 5:(3):224.
     [Google Scholar]
  7. Lee HK, Kang BS, Kim CS, Choi HJ. Ultrasound-guided regional anesthesia for the pain management of elderly patients with hip fractures in the emergency department. Clin Exp Emerg Med. 2014 Sept; 1:(1):49–55.
     [Google Scholar]
  8. Nejati A, Teymourian H, Behrooz L, Mohseni G. Pain management via Ultrasound-guided Nerve Block in Emergency Department; a Case Series Study. Emerg (Tehran). 2017; 5:(1):e12.
     [Google Scholar]
  9. Stone MB, Wang R, Price DD. Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008; 26:(6):706–10.
     [Google Scholar]
  10. Marhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997 Oct; 85:(4):854–7.
     [Google Scholar]
  11. Kayser V, Besson JM, Guilbaud G. Evidence for a noradrenergic component in the antinociceptive effect of the analgesic agent tramadol in an animal model of clinical pain, the arthritic rat. Eur J Pharmacol. 1992 Nov 24; 224:(1):83–8.
     [Google Scholar]
  12. Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL, et al. Complementary and synergistic antinociceptive interaction between the enantiomers of tramadol. J Pharmacol Exp Ther. 1993; 267:(1):331–40
     [Google Scholar]
  13. Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. Am J Roentgenol. 1998 Dec; 171:(6):1631–6.
     [Google Scholar]
  14. Kulenkampff D. Anesthesia of the brachial plexus. Zentralbl Chir. 1911; 38::1337–40.
     [Google Scholar]
  15. Perlas A, Chan VWS, Simons M. Brachial plexus examination and localization using ultrasound and electrical stimulation - a volunteer study. Anesthesiology. 2003 Aug; 99:(2):429–35.
     [Google Scholar]
  16. Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3- in-1 blocks. Reg Anesth Pain Med. 1998 Nov-Dec; 23:(6):584–8.
     [Google Scholar]
/content/journals/10.5339/jemtac.2023.18
Loading
Ultrasound-guided supraclavicular brachial plexus block versus intravenous opioid-tramadol in providing pain relief to patients presenting with upper limb injuries to the emergency department
Journal of Emergency Medicine, Trauma and Acute Care 2023, 18 (2023); https://doi.org/10.5339/jemtac.2023.18
/content/journals/10.5339/jemtac.2023.18
/content/journals/10.5339/jemtac.2023.18
Loading

Data & Media loading...

Keyword(s): emergency department, opioids, pain score and supraclavicular block

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error