So despite a long history of POCUSing, I’ve yet to do a nerve block. Working in the ICU, it’s not a routine thing. But a couple times I’ve felt I should be able to do a block for chest trauma patients with rib fractures, and not have to wait for anasthesia availability and get immediate pain control without narcotic side effects.
So I took the opportunity to corral into a corner Peter Weimersheimer (not an easy task given his past powerlifting history!) during #puertoricoFEST2019 and pick his brains about what could be useful for ICU docs to know, and how I should go about it.
Here it is:
Weimersheimer on nerve blocks for ICU
Love to hear others’ thoughts who do this!
Love cervical plexus block for neck procedures. I think regionnal blocks has a definite role in the ICU. Thanks for emphasizing that!
The use of regionnal anesthesia for rib fractures have also been a big game changer for me in the ICU management of thoracic traumas. I have experienced with different approaches and I’m now consistently using erector spinae plane block for posterior rib fractures and serratus anterior plane block for the anterior ones. When I expect that the patient is going to be in the unit for more than 24h, I often insert a catheter at the site of the block and prescribe regular injection of anesthetic that are done by the nurses.
Even in the intubated polytrauma patients on analgesia and sedation infusions, I like to do a regionnal block if they have significant rib fractures. My anecdotal experience is that it decrease the sedation and analgesia requirements. I had some cases that I had to keep ventilating in AC because they were failing due to hypoventilation in spontaneous modes. After doing the block, they would be doing well on PSV, leading to a rapid weaning process (probably a combination of improve use of respiratory muscles which were no more « splinted » by pain and increase drive from the decrease systemic sedation and analgesia requirements).