Point of Care Ultrasound (POCUS) Nerve Block

Family physicians, internists, pain medicine physicians, and emergency room doctors frequently write for large amounts of opioids to treat acute and chronic pain. The difficulty with this approach to patient care is that heavy doses of narcotics often do not truly address the medical issue at hand and/or they lead to addiction making matters far worse. Opioid addiction is a serious problem, with over two million Americans having a dependency on opioids, with most of these individuals having been introduced to these medications by physicians. With 91 Americans dying daily from opioid overdose and roughly $75B in economic loss, the consequences of this over prescription of narcotics is devastating and the need to reduce prescriptions has never been higher.

Recognizing the dilemma, hospital systems are evaluating the number of opioid prescriptions that their physicians write and the results of these studies are often shocking. One analysis conducted by the Sanford Health System in North Dakota found that their physicians wrote for 4.3 million opioid pills in just the first quarter of 2016 alone. Being cognizant of heavy opioid prescriptions, hospitals are fighting back. One such institution is St. Joseph University Medical Center in Paterson, New Jersey, where the administration has launched a narcotic minimizing initiative called the Alternative to Opiates (ALTO) where alternative modalities are utilized to treat acute and chronic pain. As a result of ALTO’s innovative design, the program has effectively reduced the number of opioid prescriptions from its physicians by 50% since its inception- yet how is this possible?

The dilemma for physicians alternatively treating pain is that the insurance companies would rather have physicians prescribe opioids because of their low cost and high availability. However, with the rise of regional anesthetic techniques enabled by point of care ultrasound (PoCUS), providers now are able to relieve pain with targeted nerve blocks.  Physicians can now treat hip fractures with Fascia Iliaca nerve blocks, migraines with occipital nerve blocks, even former opioid abusers can have assurance that their extremity pain can be treated effectively and entirely without narcotics- all thanks to the synergy between regional anesthesia and ultrasound. As physicians gain proficiency in the usage of ultrasound for these specific nerve blocks they are discovering that not only are they being reimbursed for their work, but also that patient outcomes are improving and opioid prescriptions are decreasing. As ultrasound technology continues to become ever sophisticated, the ability of the physician to treat complex pain will continue to increase with the understanding that each person treated without opioids is a step towards reversing one of the most serious public health issues of our time.

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