Comparison between Efficacy of Analgesia Produced by Intravenous Analgesics and Ultrasound Guided Peripheral Nerve Block among Isolated Single Extremity Trauma patients in Emergency Department; An Exploratory Randomized Controlled Study

Pain is the most common complaint in a trauma emergency department. In a busy trauma ED pain management is often neglected i/v/o more life threatening injuries; however, untreated/poorly treated pain can result in complications like PTSD later on, at the same time stress response to significant pain might increase patient’s morbidity. The use of peripheral nerve block as a potent mode of anesthesia and analgesia is well approved and quite frequent among anesthetists inside OT. Pain management in trauma ED has been conventionally done with IV analgesics (Paracetamol, opioids, NSAIDs). Often, some of these drugs are contraindicated in a polytrauma patient (eg:  opioids should be used cautiously in head injury patients). The use of peripheral nerve block for analgesia in trauma ED is an area yet to be adequately explored. Through this study, we are trying to establish a new pain management protocol for acute trauma victims for better patient satisfaction.

Acute trauma patients coming to trauma emergency will be first managed as per ATLS protocol and then will be evaluated based one of inclusion and exclusion criteria. Randomization will be then done and after informed consent patients will be treated with conventional IV analgesics(Inj Paracetamol 1gm IV 6th hourly with Inj Tramadol 15mg/kg 8th hourly)/peripheral nerve block (Inj Bupivacaine 0.25% @ 0.3ml/kg). The efficacy of analgesia will be compared using NRS (Numeric Rating Score) hourly along with other parameters like vitals, adverse effects of used medications, patient satisfaction etc.

There are some studies proving the efficacy of peripheral nerve block over IV analgesics in trauma emergency, however, as per the author’s knowledge, no Indian study has been done in this regard so far. So this study will help in developa ing new pain management protocol for better patient management as well as satisfaction.