Hi folks! One aeromedical retrieval shift this year I had two cases in which prehospital regional anaesthesia was useful for patient care.
One was done anatomically without USS (I had forgotten to take the machine as was tasked on a completely different job earlier in the day!), the second case was done with USS ( duly remembered to take machine that time!)
First case was a guy who had fallen off his horse and broke his femur. That was pretty obvious. No USS so I performed a Fascia Iliaca block with bupivicaine ( dont ask why we dont have ropivicaine..;-))
Worked really well and made it much easier to stretcher handle this 100+kg bloke onto a vehicle.
This video from Dr Al Sacchetti ( If you follow EMRAP and Essentials of EM you will know who Al is!) is awesome demonstration of the Fascia Iliaca block
Easy technique right? very handy in upper leg injuries in prehospital setting. Also this patient had dysphoric reaction to fentanyl we gave him supplementally so the regional anaesthesia was much better for him
Second case was a guy who had fallen off a truck ..yeah bit of a theme on this day!
Landed on his elbow and it appeared swollen and bruised. When we got to him I did an USS assessment of his elbow and humerus and he looked like he had a supracondylar fracture. He already had some morphine but pain still 8/10.
So we did an USS guided inplane supraclavicular block with plain lignocaine, to last the air transport time back to the base hospital. All done in 8 minutes and excellent analgesia obtained.Very basic setup : disposable sterile Tegaderm dressing cover as probe cover, 21g needle, 10ml 1% lignocaine in syringe, alcohol skin prep wipes, sterile gloves, assistant to hold probe once anatomy insonated.
here is a useful video of the technique.
Heal with steel..needle 😉
Stay safe out there folks
4 thoughts on “Prehospital regional anaesthesia”
Great stuff. Minh, how do you maintain regional anaes skills? Do you guys spend a couple of weeks each year in the tertiary centre,blocking everything?
ED time helps a lot ;-). lots of fractures to block whilst awaiting ortho admit ;-(
Must admit with USS now, takes a lot of guess work and partial block effects away ! Upper limb blocks were always exciting without USS but now much less exciting and more effective and safer!
I regard regional and local anaesthesia to be essential skills of ED and rural GPs. We should all know the dental and facial blocks.
A lot you dont need USS but when it comes close to ..say pleura..its v handy!
Military anaesthesia is really growing in this area of prehospital and retrieval regional anaesthesia techniques with placement of catheters and infusions of local anaesthesia.
And to be honest the skill set for a lot of the superficial nerve blocks is not hard to acquire or teach. I teach rural nurses to do digital and ankle nerve blocks with great success.
A helpful tip for the fascia iliaca block: Instead of using a sharp needle to pierce the skin, then a more dull one to feel the fascial layers, just use a standard peripheral cath. The catheter on the outside of the needle makes the fascial pops very easy to feel. Once inside just withdraw the needle and inject through the catheter