A Research-Informed Opportunity
For rural emergency clinicians, achieving safe, effective analgesia—particularly for long transfers or painful procedures requiring sedation—can be challenging. Ultrasound-guided nerve blocks (UGNBs) are increasingly recognised as a valuable tool to bridge this gap. But as researchers as well as clinicians, we need to ask: what does the evidence say, and where are the gaps?
A recent scoping review (May 2025) identified 34 randomised trials, 30 non-randomised prospective studies, and 23 retrospective observational studies on UGNBs in emergency care. Lower extremity blocks were most frequently reported, while publications on truncal blocks—particularly the erector spinae plane block—have surged in the past five years. Overall complication rates were low (0.89%), with only three cases (0.03%) of local anaesthetic systemic toxicity
A retrospective analysis of 420 emergency practitioner–performed UGNBs at a Californian ED found them both safe and highly effective. Pain scores dropped by an average of 4.6 points, and only one complication (an arterial puncture without sequelae) was reported. The most common blocks were femoral nerve/fascia iliaca, serratus anterior, and erector spinae.
Closer to home, the SABRE RCT conducted in NSW metropolitan and regional EDs showed that serratus anterior plane blocks for rib fractures more than doubled the number of patients achieving meaningful pain relief at 4 hours, and halved opioid requirements over 24 hours.
Importantly, nerve blocks aren’t just for doctors. A small rural NSW study from over a decade ago demonstrated that paramedics could safely perform landmark-guided fascia iliaca blocks for patients with suspected femoral fractures. However, the literature evaluating ultrasound-guided nerve blocks by paramedics remains sparse—despite the potential benefits in rural settings with prolonged transport times.
While the literature shows UGNBs are safe and effective in metropolitan and regional EDs, rural implementation is under-researched. Key questions include:
- How do we train and maintain skills in low-volume settings?
- Do the risk-benefit profiles differ in rural populations?
For RRECN members, this is a low-cost, high-impact opportunity to combine clinical care and research.
Check out the implementation science section of this newsletter and get in touch if you’re interested in developing a rural UGNB project—we’d love to support and showcase your work.
First published in the RRECN Newsletter (September 2025).
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