Publications

2021

Duggan, Nicole M, Arun Nagdev, Bryan D Hayes, Hamid Shokoohi, Lauren A Selame, Andrew S Liteplo, and Andrew J Goldsmith. (2021) 2021. “Perineural Dexamethasone As a Peripheral Nerve Block Adjuvant in the Emergency Department: A Case Series.”. The Journal of Emergency Medicine 61 (5): 574-80. https://doi.org/10.1016/j.jemermed.2021.03.032.

BACKGROUND: Acute pain is one of the most common complaints encountered in the emergency department (ED). Single-injection peripheral nerve blocks are a safe and effective pain management tool when performed in the ED. Dexamethasone has been explored as an adjuvant to prolong duration of analgesia from peripheral nerve blocks in peri- and postoperative settings; however, data surrounding the use of dexamethasone for ED-performed nerve blocks are lacking.

CASE SERIES: In this case series we discuss our experience with adjunctive perineural dexamethasone in ED-performed regional anesthesia. Why Should an Emergency Physician be Aware of This?: Nerve blocks performed with adjuvant perineural dexamethasone may be a safe additive to provide analgesia beyond the expected half-life of local anesthetic alone. Prospective studies exploring the role of adjuvant perineural dexamethasone in ED-performed nerve blocks are needed. © 2021 Elsevier Inc.

Selame, Lauren Ann, Kathleen McFadden, Nicole M Duggan, Andrew J Goldsmith, and Hamid Shokoohi. (2021) 2021. “Ultrasound-Guided Transgluteal Sciatic Nerve Block for Gluteal Procedural Analgesia.”. The Journal of Emergency Medicine 60 (4): 512-16. https://doi.org/10.1016/j.jemermed.2020.10.047.

BACKGROUND: Adequate analgesia is difficult to achieve in patients with an abscess requiring incision and drainage (I&D). There has been a recent increase in regional anesthesia use in the emergency department (ED) to aid in acute musculoskeletal pain relief. Specifically, transgluteal sciatic nerve (TGSN) block has been used as an adjunct treatment for certain chronic lumbar and lower extremity pain syndromes in the ED.

CASE REPORT: A 21-year-old woman presented to the ED with a painful gluteal abscess. The pain was so severe that the patient barely tolerated light palpation to the abscess area. Using dynamic ultrasound guidance, a TGSN block was performed with significant pain reduction. Ultrasonographic confirmation of abscess was obtained followed by definitive I&D. She was discharged from the ED and her incision site was healing well at the time of follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abscess I&D is a common procedure in the ED. Procedural analgesia for I&D can be difficult to obtain. We describe the TGSN block as an additional analgesic option to be used for procedural analgesia. The use of regional anesthesia has the potential to decrease unwanted and at times dangerous side effects of opiate use and resource utilization of procedural sedation while optimizing patient comfort.

2020