POCUS-Guided Forearm Nerve Blocks for Analgesia of Acute Hand Ischemia in the Emergency Department

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Abstract
Background: Acute limb ischemia (ALI) is a vascular emergency associated with significant pain that can be challenging to manage, especially in opioid-tolerant patients. Case Report: A 44-year-old man with opioid use disorder presented with ALI of the right hand not amenable to surgical intervention after self-injection of fentanyl. Despite high-dose opioids, he continued to experience refractory pain. Point of care ultrasound (POCUS)-guided radial and median nerve blocks performed in the emergency department provided substantial relief. Discussion: This case illustrates the novel use of POCUS-guided upper extremity regional anesthesia by emergency physicians to manage ALI pain. POCUS-guided regional anesthesia may be a safe, effective adjunct in select patients, though patients must be closely monitored for complications.

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