Unique considerations in regional anesthesia for emergency department and non-or procedures

Abstract

The only interface that many patients have with medical systems often occurs in the emergency department (ED) setting. It is in these front-line arenas that patients present with uncontrolled pain from a variety of sources, including trauma or pre-existing medical conditions. Intervening on behalf of patients in this setting has the potential to decrease hospital admissions, decrease the overall opioid load in the community, and unburden over-whelmed ED systems. There are a variety of conditions for which the application of regional anesthesia in this environment may be bene fi cial. Further, patients in the ED setting may bene fi t from the creation of collaborative analgesic efforts with anesthesiologist colleagues to ensure that regional anesthesia is consistently performed in a safe and ef fi cacious manner that is consistent with contemporary ASA and ASRA Pain Medicine guidelines. 1,2 In addition, emergency medicine residency training has grown to include regional ultrasound training. Ultrasound-guided regional anesthesia is now viewed as a valuable skill among emergency medicine residency programs, but few have established formal credentialling pathways. 3 There are a variety of potential concerns associated with regional anesthesia in the ED that may be related to either training, patient follow-up, or complication management. However, these likely represent obstacles that can be thoughtfully overcome in most settings to not preclude regional anesthesia offerings to patients in need. Similarly, while efforts to extend the bene fi ts of regional anesthesia to patients in the perioperative setting have been greatly successful, there remain signi fi cant patient cohorts who experience pain in the setting of nonoperating room anesthesia (NORA) encounters that might also bene fi t from a reappraisal of analgesic strategies. NORA represents an increasing share of anesthetizing locations and is projected to represent greater than 50% of all cases in the next decade. 4,5 These cases can be incredibly diverse in scope and can involve collaborations with specialists within psychiatry, gastroenterology, cardiology, interventional