Early Ultrasound-guided Nerve Block for Painful Hand Injuries in the Emergency Department

• Status: Completed
• Trial end date: 2018-07-10
• Target enrollment: 0
• Participant gender: All

Summary

This study aims to determine whether early initiation of temporary nerve block therapy improves patient satisfaction, decreases patient pain and discomfort, decreases the use of dangerous medications such as narcotics, and frees hospital resources. Hand injuries, such as blast injuries from fireworks, can be very painful. In the emergency department, providers generally use narcotic pain medications to control pain, but these have significant side effects. It is possible that temporary nerve blocks, guided by ultrasound, can be safe and useful in the emergency department. They have been shown to be effective in several studies around the country. The goal of this study is to build on the experience of others to increase the use of US-guided regional nerve blocks as a form of pain management in hand and distal forearm injuries in the Harborview Medical Center (HMC) emergency department. By working with a multidisciplinary team, the study investigators hope to use this technique to decrease narcotic use and improve pain control, and to provide important data for Emergency Medicine physicians elsewhere who are considering incorporating this nerve block technique into their practice.

• Phase: N/A
• Accepts Healthy Volunteers?: Accepts Healthy Volunteers

Details

• Lead Sponsor: University of Washington
• Treatments: Bupivacaine; Epinephrine; Epinephryl borate; Lidocaine; Racepinephrine

Criteria

Inclusion Criteria:

• Patient with moderate to severe hand blast injury or other significantly painful hand or distal forearm injury Also, patients who...

• Are awake and alert

• Are able to endorse or rate their pain

• Require intravenous pain medication for their hand injury

• Are determined to be clinically sober for consent. They will need to be fluent of speech and able to articulate understanding of the procedure they will undergo and the study they will enter.

Exclusion Criteria:

Patient's who...

• Require surgical management, within one half hour, for any injury

• Require any emergent care, including resuscitation, the should preclude their regional pain management

• Are hemodynamically unstable

• Have signs of coagulopathy

• Have clinical features suggestive of compartment syndrome of the forearm, including:

• Tense or firm forearm compartment

• Expanding hematoma

• Regional neurologic deficit (weakness or numbness)

• Have weakness or a sensory deficit in an intact part of their hand or forearm

• Have a vascular injury proximal to the hand

• Are unconscious or otherwise unable to endorse or rate their pain

• Are not deemed clinically sober enough to articulate an understanding of the procedure they will undergo and the study they will enter.

• Are prisoners

• Are <18 years old