441: Blocking the Pain: Ultrasound-Guided Peripheral Nerve Blocks in Emergency Department Trauma Patients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute posttraumatic pain, Treatment/management

Background and Aims: This case series describes five Emergency Department (ED) patients who received Ultrasound-guided peripheral nerve blocks (USGPBNs) for severe upper and lower extremity trauma. The use of USGPNBs for pain management remains scarce in EDs across the Philippines. As of the writing, this report details the first case series of USGPNBs performed in EDs across the Philippines.

Methods: Two cases of femoral nerve block secondary to femoral fracture. An infraclavicular brachial plexus block for a patient with a humeral fracture. Median and radial nerve blocks for a patient with a right thumb avulsion. Finally, a posterior tibial nerve block in a patient with an Achilles tendon tear. For all these cases, performance of USGPNB using bupivacaine 0.20% provided complete pain relief without administration of additional pain medications.

Results: This case series highlights that USGPNBs provide significant pain reduction in the described patients. This adequate pain control led to a decreased need for postoperative analgesics in two cases. Two cases required no additional pain medication while in the ED and were discharged for outpatient follow-up. And lastly one case allowed the patient to painlessly transfer to hospital of choice. These results suggest that the integration of USGPNBs into standard ED practice warrants further exploration to potentially decrease reliance on conventional pharmacological treatments such as NSAIDs and opioids. All cases were monitored until 2hrs post procedure without any adverse effects.

Conclusions: This case series demonstrates that ultrasound-guided peripheral nerve blocks (USGPNBs) provide rapid, safe, and effective pain relief in emergency trauma cases while significantly reducing opioid reliance. Ultrasound guidance ensures high precision with minimal complications. Due to limited participants of this case series, particularly larger, multi-center trials, is encouraged to further confirm these findings and explore broader applications, including continuous nerve block techniques.

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Presenting Author: Dr. Rosalee E. Gonzales
Submitting Author: Rosalee Gonzales

Senior Author: Francisco Wynie B. Butay Jr.

IASP 2026 Global Year theme of Neuropathic Pain: No

• Rosalee E. Gonzales: Doctor of Medicine - St. Luke's Medical Center Quezon City