The American journal of emergency medicine
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Case Reports
Treatment of shoulder pain with ultrasound-guided interfascial plane block: A case series.
Shoulder pain is a common presentation to the Emergency Department (ED). Despite an increasing volume of ED visits for shoulder pain, achieving adequate pain control can be challenging. Ultrasound-guided nerve blocks, such as the interscalene nerve block (ISB), are effective but can cause hemidiaphragmatic paresis and motor dysfunction. The interfascial plane block (IPB) is a simple and new regional anesthesia technique that spares the diaphragm, and most upper extremity motor function. ⋯ The ultrasound-guided IPB is a simple, safe, and effective alternative approach to treating shoulder pain in the ED, especially in patients who may not tolerate ISB.
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This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids. ⋯ Over the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals underscore the need for standardizing pain management strategies in this population.
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Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3mg/kg) to low-dose (<0.3mg/kg) intravenous (IV) ketamine among older ED patients. ⋯ High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.