Ultrasound placement of needle in three-in-one nerve block

Abstract

much less likely than a ulcerative bleed. A current database search has failed to identify evidence for the use of iv terlipressin in non variceal bleeds and we conclude that in the abscence of known varices it's use should be restricted. Abstract A short cut review was carried out to establish whether beta blockers should be used in the treatment of chest pain associated with cocaine use. 12 papers were found, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that Beta Blockers should not be used in the treatment of cocaine induced myocardial ischaemia.

Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures

“…This allows a clinician the ability to guide the needle and safely insert anesthetic solution around the nerve (Figure 1). Various studies have been conducted to demonstrate the ease and safety of performing ultrasound guided FNB [15,16,[20][21][22]. Anesthesia and Emergency Medicine literature has demonstrated ultrasound guided FNBs can lead to faster and improved quality of nerve blocks [9,11,16,20,21].…”

Emergency Department Evaluation and Treatment of Acute Hip and Thigh Pain

“…This ultrasound-guided block is a safe and simple technique for anesthesia in femur fractures and soft tissue injuries of the anterior thigh. [124][125][126][127][128][129][130][131][132][133] The 3-in-1 FNB is a variation of the fascia iliaca and FNB, targeting the lateral cutaneous nerve of the thigh and obturator nerve. It requires more local anesthetic and direct pressure 2-4 cm distal to the injection site to allow anesthesia of both branches of the femoral nerve.…”

“…[125][126][127] An EP can perform the 3-in-1 block in an average of 8 minutes with minimal training. 125,127,132,[134][135][136] The EP should be aware that any nerve block may mask compartment syndrome by compromising the limb's neurologic examination. The authors advise consulting the admitting team before performing FNB.…”

Femoral nerve blocks in fractures of femur: variation in the current UK practice and a review of the literature

“…Both these methods, elicitation of paraesthesia or nerve stimulation have modest sensitivity for detection of needle to nerve contact 32. Moreover, the use of NS can cause muscle contraction that can worsen pain and may displace the fracture 33. Therefore, neither method is ideal in ED setting.…”