Pain is the most common complaint of patients presented to the emergency department with injury and fracture.

Pain management is an important but often challenging task for emergency providers. Oral and intravenous analgesics have inherent risks, which may limit their use in certain populations, such as the elderly. Nonsteroidal inflammatory drugs, for example, can cause kidney injury and gastrointestinal bleeding and are associated with high rates of hypersensitivity reactions. Opiates can cause sedation, apnea, and Hypotension.

As a result of concerns regarding the safety profiles patients often receive suboptimal pain management in the ED.

Ultrasound-guided nerve blocks offer effective and safe alternatives to systemic analgesics to manage pain in the ED.

Blocks can be used as effective and safe tools for pain management in ED as it does not require airway monitoring or long-term care.

Hematoma, infection, and pneumothorax are among its complications. However, using the ultrasound guided method reduces these side effects.

Ultrasound-guided nerve block, decreases pain by more than 75% and reduces patients pain from severe (NRS>8) to tolerable (NRS=2) with minimal side effects.

Both physicians and patients were satisfied with pain reduction using this method regardless of the block location.

Various side effects have been reported for nerve blocks, which can be divided to local and systemic.

Local side effects are the side effects that manifest due to needle at the site of injection. Some of these side effects such as arterial puncture, hematoma at the site of injection, infection, phlebitis and thrombosis are common among all types of nerve blocks. Some of the other side effects depend on the anatomic site of the nerve block and its technique as well as the experience of the person performing the nerve block.

These include side effects such as: pneumothorax/hemothorax (infraclavicular, supraclavicular and rarely interscalene nerve block) and arteriovenous fistula.

Systemic side effects can happen because of direct injection of anesthetic into the artery or vein which are very rare, and negligible with ultrasound.

Nerve block is a relatively new concept in the ED. Considering the importance of pain management in ED and the limited work on Ultrasound guided nerve blocks, aimed to investigate the efficacy and feasibility of this technique in the ED.

Targeted Population
Patients who had pain in their upper or lower extremities following trauma and injury, with pain severity higher than or equal to 4, based on numeric rating scale (NRS), were included.
Finding a neurological defect in physical examination;
planning to transfer the patient to the operation room within 2 hours;
allergic history to local anesthetics;
infection, hematoma or active bleeding at the site of injection;
closed fractures (due to the risk of compartment syndrome);
unstable vital signs or
Glasgow coma scale < 15;
using narcotic agents in the past 24 hours; pregnancy;
moderate to severe head trauma with prolonged vomiting,
severe progressive headache, rhinorrhea, otorrhea and bleeding from ear and nose;
serious thoracic, abdominal or vertebral injuries;
speech difficulties;
intoxication with alcohol and drugs;
mental retardation; and
history of seizure were among the exclusion.

One hour after the nerve block, patients blood pressure and heart rate were checked again. Satisfaction of patient and physician from the procedure was recorded based on 5 tiered Likert scale. Satisfaction rate ranged from 5 meaning highly satisfied to 1 meaning highly unsatisfied.

Patients were monitored for two hours and possible complications such as nausea/vomiting, seizure, headache, hypotension and any other complications were recorded.