Ultrasound-guided supraclavicular brachial plexus block versus intravenous opioid-tramadol in providing pain relief to patients presenting with upper limb injuries to the emergency department
Authors: Choudhary Chetan , Nithyanand M , Jain Abhishek , Choudhary Vinita 
Published: July 2023

Introduction: Pain is the most common complaint in patients presenting to an emergency department (ED). Providing safe and effective pain management is an essential part and primary goal of initial ED management. It can be challenging, especially with a significant injury such as a humerus fracture or any long-bone injury. The movement of patients to get X-rays or transfer to a special bed can cause additional pain. Patients experiencing greater pain will more likely require extended hospital stays, be slower to mobilize, and experience a lower quality of life-related to their health.

Aim and Objectives: 1. This study aimed to compare the efficacy of ultrasound-guided supraclavicular brachial plexus block and intravenous tramadol in relieving pain in patients with isolated upper limb injuries who are presented to the ED. 2. To study the efficacy and safety of ultrasound-guided supraclavicular brachial plexus block for the management of pain caused due to upper limb injuries in ED.

Methods: A total of 40 patients with isolated upper extremity closed injuries (dislocations and fractures) who were presented to ED were investigated in this study. Eligible patients were asked to choose USG-guided SCB or intravenous tramadol treatment for pain management. For their initial analgesia, participants in Group A were given ultrasound-guided supraclavicular brachial plexus block, while Group B received 50 mg intravenous tramadol for over 10 min. After the treatment, patients were assessed for pain relief at 0 min, 15 min, 30 min, and 1 hour in both groups, and their vitals and pain score were recorded. The duration of pain relief, complication, and usage of rescue drugs was recorded, and the efficacy of both methods was compared. All patients were investigated with an X-ray or CT scan (if required) to confirm their diagnosis. Clinical information was recorded for 60 minutes, and patients were discharged or admitted.

Results: Of the patients who were presented with upper extremity injuries, only 40 were enrolled in this study. USG-guided SCB was performed on Group A (n = 20) patients. Alternatively, Group B (n = 20) patients received intravenous tramadol 50 mg. In Group A, female patients were higher in number. In contrast, the opposite was noted in Group B. Road traffic accidents was considered the most common way of causing injury, and the most common injury was fractures. The shoulder was more commonly injured than the other parts. The mean pain score in Group A patients on arrival was 8.2, while that of Group B patients was 7.1. After the therapy, the mean pain score in Group A was drastically reduced to 2.9; in Group B, it was reduced to only 4.45. Further, the requirement for additional analgesics was higher in the tramadol group than in the ultrasound-guided supraclavicular block group. 23 out of 40 patients were admitted for further care and management.

Conclusion: In patients with upper limb injuries to the ED, ultrasound-guided supraclavicular block can provide better pain relief and be more efficacious than parenteral tramadol treatment.