Nerve Blocks

Because crying rooms should not exist 

The Problem

An estimated 80% of injured persons in low-resourced settings receive inadequate or no pain treatment due to poverty, poor healthcare systems, international regulation of opioid analgesics, and discriminatory attitudes. 

New approaches to pain management are needed.  

An InnovationsCZ team determined that ultrasound regional anesthesia (USRA) was a viable solution and developed programs to demonstrate proof-of-concept, skill transferability, and sustainability. 

The Solution
The Approach

A 1-year pilot program was developed in Goma, Democratic Republic of Congo (DRC) using a training course and clinical mentoring format, Later, we expanded to 3 large urban referral trauma centers in DRC and Ethiopia. The locations had orthopedic or emergency medicine educational programs and represented a diverse spectrum of resource limits as well as a disparate scale of sophistication of personnel and infrastructure. 

Through grants, we provided ultrasound machines to trainees in exchange for their commitment to protocols and procedures. USRA single-use kits were constructed to be inexpensive and practical with needed equipment for safe, sterile USRA technique. Faculty with specialty training provided 3 additional weeks of clinical mentoring, requiring trainees to pass a practical exam before conducting unsupervised USRA. All patients were monitored while in-hospital for delayed complications.

Over 5 years, InnovationsCZ has trained 102 providers in Democratic Republic of Congo and Ethiopia, yielding 1,853 procedures. Participating doctors and patients reported dramatic decreases in injury-related pain. The cost for consumable supplies was negligible at estimated cost-per-procedure of less than $1. 

A 5-year follow-up showed USRA adopted into routine patient care.

We plan to build regional networks to share instructors, establish maintenance cooperatives, and control data acquisition to allow this skill to be developed safely. A randomized trial is currently underway to determine the most appropriate approach for skill acquisition and retention. If USRA allows more procedures in emergency rooms, wait times for definitive care and time in the operating theatre may be decreased.

Next Steps