MANAGEMENT OF AN ACUTE EXACERBATION OF CHRONIC NEUROPATHIC PAIN IN THE EMERGENCY DEPARTMENT: A CASE TO SUPPORT ULTRASOUND-GUIDED FOREARM NERVE BLOCKS

被引:9
作者
Canders, Caleb P. [1 ]
Krishna, Pravin K. [1 ]
Moheimani, Roya S. [1 ]
Weaver, Catherine M. [1 ]
机构
[1] Univ Calif Los Angeles, Med Ctr, Dept Emergency Med, Los Angeles, CA USA
关键词
ulnar nerve block; ulnar neuropathy; chronic neuropathy; ultrasound-guided nerve block; DORSAL-ROOT-GANGLIA; CARPAL-TUNNEL; ANESTHESIA; ULNAR;
D O I
10.1016/j.jemermed.2018.08.003
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Acute on chronic neuropathic pain is often refractory to analgesics and can be challenging to treat in the emergency department (ED). In addition, systemic medications such as opiates and nonsteroidal inflammatory drugs have risks, including hypotension and kidney injury, respectively. Difficulties in managing pain in patients with neuropathy can lead to prolonged ED stays, undesired admissions, and subsequent increased health care costs. Case Report: We describe the case of a 51-year-old woman who presented to the ED on two separate occasions for left forearm pain secondary to chronic ulnar neuropathy. During her first ED visit, the patient received multiple rounds of intravenous opiates and required hospital admission, which was complicated by opiate-induced hypotension. During her second visit, she underwent an ultrasound-guided ulnar nerve block performed by the emergency physician; her pain resolved and she was discharged home. Why Should Emergency Physicians Be Aware of This?: Ultrasound-guided nerve blocks are an effective, safe, and relatively inexpensive alternative to opioids. Our case demonstrates that emergency providersmay be able to performultrasound-guided regional anesthesia to treat an acute exacerbation of chronic neuropathic pain. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:E147 / E151
页数:5
相关论文
共 19 条
[1]  
Abram SE, 2000, CLIN J PAIN S, V16, pS58
[2]   PROLONGED RELIEF OF NEURALGIA AFTER REGIONAL ANESTHETIC BLOCKS - A CALL FOR FURTHER EXPERIMENTAL AND SYSTEMATIC CLINICAL-STUDIES [J].
ARNER, S ;
LINDBLOM, U ;
MEYERSON, BA ;
MOLANDER, C .
PAIN, 1990, 43 (03) :287-297
[3]   NEUROGENIC PAIN SYNDROMES AND THEIR MANAGEMENT [J].
BOWSHER, D .
BRITISH MEDICAL BULLETIN, 1991, 47 (03) :644-666
[4]   CONTRIBUTION OF CENTRAL NEUROPLASTICITY TO PATHOLOGICAL PAIN - REVIEW OF CLINICAL AND EXPERIMENTAL-EVIDENCE [J].
CODERRE, TJ ;
KATZ, J ;
VACCARINO, AL ;
MELZACK, R .
PAIN, 1993, 52 (03) :259-285
[5]   Injection with methylprednisolone proximal to the carpal tunnel: randomised double blind trial [J].
Dammers, JWHH ;
Veering, MM ;
Vermeulen, M .
BRITISH MEDICAL JOURNAL, 1999, 319 (7214) :884-886
[6]   Ultrasound-Guided Forearm Nerve Blocks in Kids A Novel Method for Pain Control in the Treatment of Hand-Injured Pediatric Patients in the Emergency Department [J].
Frenkel, Oron ;
Liebmann, Otto ;
Fischer, Jason W. .
PEDIATRIC EMERGENCY CARE, 2015, 31 (04) :255-259
[7]   Ultrasound guidance for ulnar nerve block in the forearm [J].
Gray, AT ;
Schafhalter-Zoppoth, I .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 2003, 28 (04) :335-339
[8]   Opioid Prescribing in a Cross Section of US Emergency Departments [J].
Hoppe, Jason A. ;
Nelson, Lewis S. ;
Perrone, Jeanmarie ;
Weiner, Scott G. .
ANNALS OF EMERGENCY MEDICINE, 2015, 66 (03) :253-259
[9]   Door-to-block time: prioritizing acute pain management for femoral fractures in the ED [J].
Johnson, Brian ;
Herring, Andrew ;
Shah, Swapnil ;
Krosin, Michael ;
Mantuani, Daniel ;
Nagdev, Arun .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2014, 32 (07) :801-803
[10]   Prevalence of neuropathic pain in emergency patients: an observational study [J].
Lecomte, Francois ;
Gault, Nathalie ;
Kone, Victoria ;
Lafoix, Cecile ;
Ginsburg, Christine ;
Claessens, Yann-Erick ;
Pourriat, Jean-Louis ;
Vidal-Trecan, Gwenaelle .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2011, 29 (01) :43-49