Academic Journal
Regional anesthesia in the emergency department: A review of key pharmacotherapeutic considerations.
| Τίτλος: | Regional anesthesia in the emergency department: A review of key pharmacotherapeutic considerations. |
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| Συγγραφείς: | Ray L; Department of Pharmacy, Denver Health Medical Center, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, United States of America. Electronic address: lanceray@gmail.com., Gottlieb M; Department of Emergency Medicine, Rush University Medical Center, United States of America., Long B; Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America., Riscinti M; Department of Emergency Medicine, Denver Health Medical Center, United States of America; University of Colorado School of Medicine, United States of America., Rech MA; Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America. |
| Πηγή: | The American journal of emergency medicine [Am J Emerg Med] 2026 Jul; Vol. 105, pp. 63-72. Date of Electronic Publication: 2026 Apr 03. |
| Τύπος έκδοσης: | Journal Article; Review; Research Support, U.S. Gov't, Non-P.H.S. |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1983- : Philadelphia, PA : W B Saunders Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]- |
| Ιατρικοί όροι (MeSH): | Anesthesia, Conduction*/adverse effects , Anesthesia, Conduction*/methods , Anesthesia, Conduction*/trends , Anesthetics, Local*/administration & dosage , Anesthetics, Local*/adverse effects , Anesthetics, Local*/chemistry , Anesthetics, Local*/pharmacology , Emergency Service, Hospital*/trends , Nerve Block*/adverse effects , Nerve Block*/methods , Nerve Block*/trends, Hemorrhage/etiology ; Hemorrhage/prevention & control ; Evidence-Based Medicine/methods ; Evidence-Based Medicine/trends ; Humans ; Molecular Structure ; Patient Care Team ; Structure-Activity Relationship ; Ultrasonography, Interventional |
| Περίληψη: | Introduction: Opioid-associated risks and the opioid epidemic have accelerated interest in multimodal analgesia in the emergency department (ED). Regional anesthesia offers a targeted approach with reduced risk of systemic adverse effects and is increasingly used under ultrasound guidance. Objective: This concise, evidence-based review explores pharmacological principles of local anesthetics describing key aspects of structure-activity relationship, providing context for agent selection. Additional considerations include dosing strategy, adjunctive medications, potential risks, toxicity mitigation, and operationalization of regional anesthesia in the ED. Discussion: Regional anesthesia is used with increased frequency in the ED. Pharmacologic properties of commonly used local anesthetics and adjunctive agents determine their advantages and limitations as well as place in therapy. There are a variety of anesthetic agents, including amides (e.g., lidocaine, bupivacaine, ropivacaine, levobupivacaine) and esters (e.g., articaine, chloroprocaine) with differences in onset, duration, and toxicity profiles that influence agent selection in ED patient populations. Adjuncts such as epinephrine, dexamethasone, and alpha-2 agonists may extend nerve block duration or improve analgesia but introduce safety and operational considerations. Recognition of local anesthetic systemic toxicity (LAST) remains central to safe practice, underscoring the importance of weight-based dosing, ultrasound guidance, monitoring, and immediate access to lipid emulsion therapy. Systems-based approaches such as order sets, pharmacist involvement, and structured training support consistent and safe application of regional anesthesia in the ED setting. Conclusions: Safe integration of regional anesthesia in the ED requires pharmacologic literacy, standardized systems, and multidisciplinary support to optimize analgesia while minimizing risk. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The above authors have nothing to declare relevant to this work. |
| Contributed Indexing: | Keywords: Analgesia; Local anesthetics; Nerve block; Pain; Pharmacotherapy; Regional anesthesia |
| Substance Nomenclature: | 0 (Anesthetics, Local) |
| Entry Date(s): | Date Created: 20260418 Date Completed: 20260520 Latest Revision: 20260601 |
| Update Code: | 20260601 |
| DOI: | 10.1016/j.ajem.2026.04.003 |
| PMID: | 42000675 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1532-8171 |
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| DOI: | 10.1016/j.ajem.2026.04.003 |