Complications of Ultrasound-Guided Peripheral Nerve Blocks in the Emergency Department: A Systematic Review and Meta-Analysis

Joyce Hanyue Gu; Adrian Cotarelo; Mark Samarneh

doi:10.1016/j.jemermed.2025.02.025

Complications of Ultrasound-Guided Peripheral Nerve Blocks in the Emergency Department: A Systematic Review and Meta-Analysis

J Emerg Med. 2025 Feb 20:S0736-4679(25)00055-1. doi: 10.1016/j.jemermed.2025.02.025. Online ahead of print.

Authors

Joyce Hanyue Gu¹, Adrian Cotarelo², Mark Samarneh³

Affiliations

¹ Medical Student at Lake Erie College of Osteopathic Medicine, Seton Hill, Pennsylvania. Electronic address: joycehanyuegu0405@gmail.com.
² Emergency Medicine, St. John's Riverside Hospital, Yonkers, New York.
³ Nephrology, St. John's Riverside Hospital, Yonkers, New York.

PMID: 40581552
DOI: 10.1016/j.jemermed.2025.02.025

Abstract

Background: Ultrasound-guided nerve block (USGNB) is a technique which employs ultrasound guidance to improve the accuracy of anesthetic delivery in nerve block procedures, which leads to decreased analgesic use, fewer adverse effects, and increased patient satisfaction. While USGNB is traditionally administered by trained anesthesiologists in the perioperative setting, it also offers potential to improve pain management practices in the emergency department (ED).

Objective: Our objective is to assess the safety of USGNB in the ED setting.

Methods: We performed a systematic review and random effects model meta-analysis to estimate the complication rates of USGNB in the ED setting and the odds ratio of complication rates compared to standard of care analgesia. We searched records retrieved from PubMed and Google Scholar. Studies which examined ED-performed USGNB and reported adverse event statistics were included.

Results: Our systematic review screen yielded 179 retrievable studies, of which we included 53. A subset of 22 studies provided calculating odds ratios compared to standard analgesia. USGNB in the ED setting demonstrated a complication rate of 0.05 (95% CI [0.03, 0.07]) and a lower odds ratio 0.17 (95% CI 29 [0.08, 0.37]) of complications compared with standard analgesia.

Conclusion: Current evidence suggests that USGNB in the ED setting confers a low risk of complications and offers safety advantages over standard analgesia.

Keywords: complications; emergency department; ultrasound-guided peripheral nerve block.