Effective pain control is a cornerstone of emergency care. Traditionally, systemic analgesics
particularly opioids have been the first line for acute pain relief. However, the rise of
regional anesthesia techniques has ushered in a new approach: on-arrival nerve blocks,
where patients receive targeted pain relief immediately upon entering the emergency care.
A nerve block involves the injection of local anesthetic near a specific nerve or plexus,
temporarily interrupting pain transmission from the affected area. When performed
promptly, often during triage or initial assessment, these blocks can drastically improve
patient comfort and facilitate downstream care. Ultrasound guidance has significantly
improved the accuracy and safety of nerve blocks. With appropriate training, providers can
safely administer these blocks.
Clinical Indications and Examples:
- Femoral nerve block: Ideal for hip fractures, especially in elderly patients, providing
immediate analgesia that aids in movement, imaging, and surgical preparation. - Interscalene or supraclavicular block: Useful for shoulder dislocations or upper limb
fractures. - Fascia iliaca block: A simpler alternative to femoral nerve block.
- Rib blocks or erector spinae blocks: Effective in cases of rib fractures, improving
ventilation and reducing risk of pneumonia.
Some of the benefits are it provides immediate and focused analgesia, Helps to reduce
opioid consumption and lowering the risk of systemic side effects of opioids, Enhanced
comfort allows patients to better tolerate diagnostic imaging, wound care, or orthopedic
manipulation, early and adequate pain control may decrease physiological stress, improve
hemodynamics, and reduce complications in trauma patients, faster and safer patient
turnover.
Contraindications include allergy to local anesthetics ,infection at the injection site, severe
coagulopathy inability to provide informed consent or assess neurological status
Challenges to widespread adoption include lack of training, time constraints, and
medicolegal concerns. However, structured protocols, checklists, and point-of-care
ultrasound have addressed many of these barriers.
In conclusion on-arrival nerve blocks are a game-changer in emergency care .By delivering
rapid, effective, and targeted analgesia at the point of entry, they not only improve patient
comfort but also enhance procedural efficiency and reduce opioid use. With growing
interest and expanding training, these blocks are poised to become standard practice
emergency care.