Ultrasound-guided regional anesthesia (UGRA) in the emergency department: a scoping review

IntroductionWhile many studies have been published on Ultrasound-guided regional anesthesia in the Emergency Department (ED), there has been no previous study assessing the current state of the literature based in the form of a scoping review.ObjectiveThe purpose of this study is to evaluate the current state of the literature on UGRA performed in the ED setting.MethodsEMBASE, MEDLINE, CINAHL, and Cochrane databases were searched for studies. Following PRISMA-ScR guidelines (Figure 1), two reviewers evaluated each title and abstract and were included if they described a UGRA technique performed on patients in the ED by an ED provider. Cohen's kappa coefficients were calculated for each level of review.Figure 1.Study selection process. From: tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, levac D, et al. PRISMA extension for scoping reviews (PRISMAScR): checklist and explanation. Ann Intern Med. 2018;169:467-473. doi: 10.7326/M18-0850. For more information, visit: https://www.prisma-statement.org/scoping.ResultsOf the 1,456 abstracts, a total of 53 articles were included in the analysis, of which 28 (52.8%) were case series and 11 (20.8%) were randomized control trials (RCTs). The most common types of nerve block represented in these studies were femoral nerve/fascia iliaca (14), brachial plexus (7), and forearm (radial, ulnar, median nerves) (7). 47 of the 53 articles were published in or after the year 2010.ConclusionCurrent literature supporting UGRA use in the ED is growing but unbalanced, requiring large population studies to demonstrate safety and efficacy of these techniques.