Ultrasound-Guided Low-Volume Brachial Plexus Block in the Supraclavicular Region for Shoulder Reduction in the Emergency Department

Overview

Acute shoulder dislocation is a common and painful condition in the emergency department (ED). Procedural sedation is widely used to facilitate reduction but is associated with potential risks and resource use. Ultrasound-guided regional anesthesia has emerged as an alternative approach. This retrospective, monocentric observational study analyzes routinely collected clinical data from an orthopedic ED between February 2018 and February 2024. Adult patients with acute shoulder dislocation are included. The study evaluates the feasibility, safety, and clinical implementation of low-volume (approximately 5 ml local anesthetic) ultrasound-guided brachial plexus block in the supraclavicular region. Outcomes include procedural success, block-related complications, and temporal trends reflecting the adoption of the technique over time.

Acute shoulder dislocation is a frequent orthopedic emergency requiring timely reduction. Procedural sedation and analgesia (PSA) is commonly used but may be associated with risks and increased resource utilization. Ultrasound-guided regional anesthesia of the brachial plexus represents an alternative approach that may allow effective reduction without systemic sedation. This retrospective, monocentric observational study is based on routinely collected clinical data from the orthopedic emergency department of the Merian Iselin Klinik Basel, Switzerland, covering the period from February 2018 to February 2024. All eligible patients with acute shoulder dislocation were included. During the study period, ultrasound-guided low-volume brachial plexus block in the supraclavicular region was progressively implemented as part of routine clinical practice. The technique used a standardized low-volume approach (approximately 5 ml local anesthetic). The aim of this study is to evaluate the feasibility and safety of this approach in a real-world setting, as well as to describe its implementation over time. Particular focus is placed on procedural success, block-related complications, and temporal trends reflecting increasing use and operator experience. The study further explores the practical aspects of integrating this technique into routine emergency care, including its applicability across a broader group of physicians in a setting with rotating staff and limited case numbers. The study is conducted in accordance with the Swiss Human Research Act (HRA) as a further use of health-related personal data without consent (Art. 34 HRA). All data are analyzed in coded form without additional interventions or patient contact.