Abstract
Background
Acute on chronic neuropathic pain is often refractory to analgesics and can be challenging
to treat in the emergency department (ED). In addition, systemic medications such
as opiates and nonsteroidal inflammatory drugs have risks, including hypotension and
kidney injury, respectively. Difficulties in managing pain in patients with neuropathy
can lead to prolonged ED stays, undesired admissions, and subsequent increased health
care costs.
Case Report
We describe the case of a 51-year-old woman who presented to the ED on two separate
occasions for left forearm pain secondary to chronic ulnar neuropathy. During her
first ED visit, the patient received multiple rounds of intravenous opiates and required
hospital admission, which was complicated by opiate-induced hypotension. During her
second visit, she underwent an ultrasound-guided ulnar nerve block performed by the
emergency physician; her pain resolved and she was discharged home.
Why Should Emergency Physicians Be Aware of This?
Ultrasound-guided nerve blocks are an effective, safe, and relatively inexpensive
alternative to opioids. Our case demonstrates that emergency providers may be able
to perform ultrasound-guided regional anesthesia to treat an acute exacerbation of
chronic neuropathic pain.
Keywords
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Article info
Publication history
Published online: September 21, 2018
Accepted:
August 3,
2018
Received in revised form:
July 15,
2018
Received:
December 1,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
