Hand Injuries Clinical Trial
Official title:
Early Ultrasound-guided Nerve Block for Painful Hand Injuries in the Emergency Department
Verified date | October 2018 |
Source | University of Washington |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study aims to determine whether early initiation of temporary nerve block therapy improves patient satisfaction, decreases patient pain and discomfort, decreases the use of dangerous medications such as narcotics, and frees hospital resources. Hand injuries, such as blast injuries from fireworks, can be very painful. In the emergency department, providers generally use narcotic pain medications to control pain, but these have significant side effects. It is possible that temporary nerve blocks, guided by ultrasound, can be safe and useful in the emergency department. They have been shown to be effective in several studies around the country. The goal of this study is to build on the experience of others to increase the use of US-guided regional nerve blocks as a form of pain management in hand and distal forearm injuries in the Harborview Medical Center (HMC) emergency department. By working with a multidisciplinary team, the study investigators hope to use this technique to decrease narcotic use and improve pain control, and to provide important data for Emergency Medicine physicians elsewhere who are considering incorporating this nerve block technique into their practice.
Status | Completed |
Enrollment | 15 |
Est. completion date | July 10, 2018 |
Est. primary completion date | July 10, 2018 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Patient with moderate to severe hand blast injury or other significantly painful hand or distal forearm injury Also, patients who... - Are awake and alert - Are able to endorse or rate their pain - Require intravenous pain medication for their hand injury - Are determined to be clinically sober for consent. They will need to be fluent of speech and able to articulate understanding of the procedure they will undergo and the study they will enter. Exclusion Criteria: Patient's who... - Require surgical management, within one half hour, for any injury - Require any emergent care, including resuscitation, the should preclude their regional pain management - Are hemodynamically unstable - Have signs of coagulopathy - Have clinical features suggestive of compartment syndrome of the forearm, including: - Tense or firm forearm compartment - Expanding hematoma - Regional neurologic deficit (weakness or numbness) - Have weakness or a sensory deficit in an intact part of their hand or forearm - Have a vascular injury proximal to the hand - Are unconscious or otherwise unable to endorse or rate their pain - Are not deemed clinically sober enough to articulate an understanding of the procedure they will undergo and the study they will enter. - Are prisoners - Are <18 years old |
Country | Name | City | State |
---|---|---|---|
United States | Harborview Medical Center / University of Washington | Seattle | Washington |
Lead Sponsor | Collaborator |
---|---|
University of Washington |
United States,
Amini R, Kartchner JZ, Nagdev A, Adhikari S. Ultrasound-Guided Nerve Blocks in Emergency Medicine Practice. J Ultrasound Med. 2016 Apr;35(4):731-6. doi: 10.7863/ultra.15.05095. Epub 2016 Mar 1. — View Citation
Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001 Sep;26(5):908-15. — View Citation
Frenkel O, Liebmann O, Fischer JW. Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department. Pediatr Emerg Care. 2015 Apr;31(4):255-9. doi: 10.1097/PEC.0000000000000398. — View Citation
Liebmann O, Price D, Mills C, Gardner R, Wang R, Wilson S, Gray A. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006 Nov;48(5):558-62. Epub 2006 Jun 14. — View Citation
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Wroe P, O'Shea R, Johnson B, Hoffman R, Nagdev A. Ultrasound-guided forearm nerve blocks for hand blast injuries: case series and multidisciplinary protocol. Am J Emerg Med. 2016 Sep;34(9):1895-7. doi: 10.1016/j.ajem.2016.06.111. Epub 2016 Jul 11. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Pain Score (1-100 visual or verbal scale) | Pain score (1-100 visual or verbal scale) at 3 hours post-block | 3 hour | |
Secondary | Complications | Complications from the nerve blocks (i.e. compartment syndrome, persistent nerve symptoms) will be measured on follow up. | 4 weeks | |
Secondary | Opioid medication use | The amount (in morphine equivalents) number of doses of opioid medications used in the emergency department will be measured. | 1 day | |
Secondary | Additional pain scores (1-100 visual or verbal scale) | Pain scores (1-100 visual or verbal scale) at time of block, 15 minutes after block, and one hour after block, and 2 hours after block. | 0 - 3 hours |
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