Impacto da ultrassonografia point-of-care sobre a anestesia regional no departamento de emergência: uma revisão narrativa da literatura
DOI:
https://doi.org/10.5281/zenodo.22314189Palavras-chave:
anestesia regional, ultrassonografia point-of-care, POCUS, departamento de emergência, bloqueio nervoso guiado por ultrassom, analgesia multimodal, segurança, opioidesResumo
O presente artigo tem por objetivo sintetizar, de forma narrativa, o impacto da ultrassonografia point-of-care sobre a prática da anestesia regional guiada por ultrassom no departamento de emergência, abordando fundamentação técnica, indicações por região anatômica, eficácia analgésica e impacto na redução do consumo de opioides, perfil de segurança, barreiras de implementação e perspectivas futuras. Metodologia: revisão narrativa conduzida nas bases PubMed, Embase e Cochrane Library, com busca estruturada em três eixos — guia ultrassonográfica/bloqueio nervoso, anestesia regional/bloqueios fasciais e serviço de emergência — e em estratégias focadas por técnica (fáscia ilíaca, femoral, eretor da espinha, serrátil anterior, PENG, interescalênico, ciático, supraclavicular) e por segurança. Resultados: a evidência disponível demonstra que a ARGU executada por emergencistas treinados reduz significativamente os escores de dor, diminui o consumo de opioides e seus efeitos adversos e abrevia o tempo de permanência no serviço de emergência, com baixa taxa de complicações em registros de larga escala; a integração com protocolos institucionais e currículos de residência constitui o principal gargalo à adoção generalizada. Conclusões: o POCUS ampliou a fronteira técnica da anestesia regional no departamento de emergência; recomendações práticas, governança clínica e pesquisas com desfechos centrados no paciente permanecem como agenda prioritária.
Referências
ABDULLAH, Mukhlef Jabr Alanazi; ALHARBI, Lama M.; ALZAHRANI, Rana Talal; et al. Radiology guided anesthesia pathways in the emergency department: effects on time to procedure, adverse events, and disposition; a systematic review. Zenodo, 2025. Disponível em: https://doi.org/10.5281/zenodo.18092611. Acesso em: 8 ago. 2026.
ABU HALIMAH, Jalal; ZALAH, Ali A.; ALAMMARI, Arwa H.; et al. Regional nerve blocks for trauma pain in the emergency department: a systematic review of efficacy and safety. Cureus, v. 17, n. 1, e82073, 2025. Disponível em: https://doi.org/10.7759/cureus.82073. Acesso em: 8 ago. 2026.
ADHIKARY, Sanjib Das; LIU, Waiman; FULLER, Edwin M.; et al. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia, v. 74, n. 4, p. 585-593, 2019. Disponível em: https://doi.org/10.1111/anae.14579. Acesso em: 8 ago. 2026.
AGASTRYA, Wayan Dhea; RAHMADINIE, Amalia. Optimizing acute pain management after trauma in the emergency department: the role of regional nerve blocks by anesthesiologists. Journal of Diverse Medical Research, v. 2, n. 7, p. 112-119, 2025. https://doi.org/10.33005/jdiversemedres.v2i7.178. Acesso em: 8 ago. 2026.
ARDON, Alberto E.; LEE, Justin; FRANCO, Carlo D.; et al. Paravertebral block: anatomy and relevant safety issues. Korean Journal of Anesthesiology, v. 73, n. 6, p. 494-500, 2020. Disponível em: https://doi.org/10.4097/kja.20065. Acesso em: 8 ago. 2026.
BEALS, Tyler; ODASHIMA, Kay; HAINES, Lawrence; et al. Interscalene brachial plexus nerve block in the emergency department: an effective and practice-changing workshop. The Ultrasound Journal, v. 11, n. 1, art. 15, 2019. Disponível em: https://doi.org/10.1186/s13089-019-0131-x. Acesso em: 8 ago. 2026.
BETCHER, Joe; GLOGOZA, Alex; POULSON, Austin; et al. Fascia iliaca vs. combined iliac blocks for proximal hip fractures in the emergency department. Western Journal of Emergency Medicine, v. 27, n. 2, p. 413-418, 2026. Disponível em: https://doi.org/10.5811/westjem.48675. Acesso em: 8 ago. 2026.
BROWN, Joseph; GOLDSMITH, Andrew; LAPIETRA, Alexis; et al. Ultrasound-guided nerve blocks: suggested procedural guidelines for emergency physicians. POCUS Journal, v. 7, n. 2, p. 253-261, 2022. Disponível em: https://doi.org/10.24908/pocus.v7i2.15233. Acesso em: 8 ago. 2026.
BURCKETT-ST LAURENT, David; METCALFE, David; SUTCLIFFE, Elliot; et al. 'Plan A' for ultrasound-guided regional anaesthesia in the Emergency Department. Emergency Medicine Journal, v. 40, n. 10, p. 691-692, 2023. Disponível em: https://doi.org/10.1136/emermed-2023-213354. Acesso em: 8 ago. 2026.
CHOI, Wookjin; CHO, Young Soon; HA, Young Rock; et al. Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective. Clinical and Experimental Emergency Medicine, v. 10, n. 4, p. 343-356, 2023. Disponível em: https://doi.org/10.15441/ceem.23.101. Acesso em: 8 ago. 2026.
D'ANDREA, Antonello; DEL GIUDICE, Carmen; FABIANI, Dario; et al. The incremental role of multiorgan point-of-care ultrasounds in the emergency setting. International Journal of Environmental Research and Public Health, v. 20, n. 3, p. 2088, 2023. Disponível em: https://doi.org/10.3390/ijerph20032088. Acesso em: 8 ago. 2026.
DE SIMONE, Belinda; CHOUILLARD, Elie; PODDA, Mauro; et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World Journal of Emergency Surgery, v. 19, n. 1, art. 8, 2024. Disponível em: https://doi.org/10.1186/s13017-024-00537-8. Acesso em: 8 ago. 2026.
DÍAZ-GÓMEZ, José L.; MAYO, Paul H.; KOENIG, Seth J. Point-of-care ultrasonography. New England Journal of Medicine, v. 385, n. 17, p. 1593-1602 2021. Disponível em: https://doi.org/10.1056/NEJMra1916062. Acesso em: 8 ago. 2026.
GOLDSMITH, Andrew; DRIVER, Lachlan; DUGGAN, Nicole M.; et al. Complication rates after ultrasonography-guided nerve blocks performed in the emergency department. JAMA Network Open, v.7, n.11, e2444742, 2024. Disponível em: https://doi.org/10.1001/jamanetworkopen.2024.44742. Acesso em: 8 ago. 2026.
HERRING, Andrew A. Bringing ultrasound-guided regional anesthesia to emergency medicine. AEM Education and Training, v. 1, n. 2, p. 120-125, 2017. Disponível em: https://doi.org/10.1002/aet2.10027. Acesso em: 8 ago. 2026.
İLHAN, Buğra; DEMİR, Cihat. Knowledge of local anesthetic systemic toxicity among emergency medicine physicians: a cross-sectional study. Signa Vitae, v. 16, n. 2, p. 115-121, 2020. Disponível em: https://doi.org/10.22514/sv.2020.16.0040. Acesso em: 8 ago. 2026.
KUMAR, Gaurav; BHOI, Sanjeev; SINHA, Tej Prakash; et al. Erector spinae plane block for multiple rib fracture done by an emergency physician: a case series. Australasian Journal of Ultrasound in Medicine, v. 23, n. 4, p. 242-246, 2020. Disponível em: https://doi.org/10.1002/ajum.12225. Acesso em: 8 ago. 2026.
LEE, Soo Hee; SOHN, Ju-Tae. Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review. Korean Journal of Anesthesiology, v. 76, n. 4, p. 282-292, 2023. Disponível em: https://doi.org/10.4097/kja.23031. Acesso em: 8 ago. 2026.
LIANG, Chen; SHEN, Yang; LIU, Shuangmei; et al. Ultrasound-guided supra-inguinal fascia iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial. BMC Geriatrics, v. 21, n. 1, art. 682, 2021. Disponível em: https://doi.org/10.1186/s12877-021-02646-4. Acesso em: 8 ago. 2026.
LIU, Yang; ZHANG, Jing; YU, Peng; et al. Mechanisms and efficacy of intravenous lipid emulsion treatment for systemic toxicity from local anesthetics. Frontiers in Medicine, v. 8, art. 756866, 2021. Disponível em: https://doi.org/10.3389/fmed.2021.756866. Acesso em: 8 ago. 2026.
MALIK, Adrienne; THOM, Stephanie; HABER, Brian D.; et al. Regional anesthesia in the emergency department: an overview of common nerve block techniques and recent literature. Current Emergency and Hospital Medicine Reports, v. 10, n. 2, p. 32-41, 2022. Disponível em: https://doi.org/10.1007/s40138-022-00249-w. Acesso em: 8 ago. 2026.
MANI, Nick; RAO, Sampreeth; KIM, Daniel J. Point-of-care ultrasound in the modern era of emergency medicine: a narrative review of the recent literature. Current Opinion in Critical Care, v. 32, n. 1, p. 45-52, 2026. Disponível em: https://doi.org/10.1097/mcc.0000000000001358. Acesso em: 8 ago. 2026.
MARRONE, Francesco; PAVENTI, Saverio. Measuring what matters in hip fracture analgesia. Anaesthesia, v. 81, n. 2, p. 215-218, 2026. Disponível em: https://doi.org/10.1111/anae.70152. Acesso em: 8 ago. 2026.
MORRISON, R. Sean; DICKMAN, Eitan; HWANG, Ula; et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. Journal of the American Geriatrics Society, v. 64, n. 12, p. 2433-2439, 2016. Disponível em: https://doi.org/10.1111/jgs.14386. Acesso em: 8 ago. 2026.
OK, Seong-Ho; HONG, Jung Min; LEE, Soo Hee; et al. Lipid emulsion for treating local anesthetic systemic toxicity. International Journal of Medical Sciences, v. 15, n. 7, p. 713-722, 2018. Disponível em: https://doi.org/10.7150/ijms.22643. Acesso em: 8 ago. 2026.
PALACHICK, Benjamin J.; CARVER, Ryan A.; BYARS, Donald; et al. Erector spinae plane blocks for traumatic rib fractures: a prospective, interventional study. The American Surgeon, v. 88, n. 8, p. 1918-1923, 2022. Disponível em: https://doi.org/10.1177/00031348221091956. Acesso em: 8 ago. 2026.
PASQUIER, Mathieu; TAFFÉ, Patrick; HÜGLI, Olivier; et al. Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial. BMC Geriatrics, v. 19, n. 1, art. 180, 2019. Disponível em: https://doi.org/10.1186/s12877-019-1193-0. Acesso em: 8 ago. 2026.
RAUSCHENBACH, Anthony; PAETOW, Glenn; MUSIAL, Hayley; et al. Implementation of regional anesthesia education for emergency medicine residents and faculty. AEM Education and Training, v. 9, n. 1, e70007, 2025. Disponível em: https://doi.org/10.1002/aet2.70007. Acesso em: 8 ago. 2026.
SRINIVASARANGAN, Madhu; SHETTY, Bellipady Shyam Prasad; PATIL, Akkamahadevi; et al. Utility of ultrasound-guided erector spinae plane block in patients presenting to the emergency department with rib fractures. Indian Journal of Pain, v. 36, n. 2, p. 89-94, 2022. Disponível em: https://doi.org/10.4103/ijpn.ijpn_90_21. Acesso em: 8 ago. 2026.
STICKLES, Sean P.; SHIPLEY KANE, Deborah; KRAUS, Chadd K.; et al. Adverse events related to ultrasound-guided regional anesthesia performed by emergency physicians: systematic review protocol. PLOS ONE, v. 17, n. 6, e0269697, 2022. Disponível em: https://doi.org/10.1371/journal.pone.0269697. Acesso em: 8 ago. 2026.
STONE, Alexander B.; GOLDSMITH, Andrew; POZNER, Charles N.; et al. Ultrasound-guided regional anesthesia in the emergency department: an argument for multidisciplinary collaboration to increase access while maintaining quality and standards. Regional Anesthesia & Pain Medicine, v. 46, n. 8, p. 726-731, 2021. Disponível em: https://doi.org/10.1136/rapm-2020-102416. Acesso em: 8 ago. 2026.
STENVERS, Elke; DIJKERMAN, L.; SCHOP, Bram P. A.; et al. Comparison of the effectiveness of fascia iliaca compartment block for preoperative pain relief in patients with intracapsular or extracapsular hip fractures. Geriatric Orthopaedic Surgery & Rehabilitation, v. 17, art. 21514593251413152, 2026. Disponível em: https://doi.org/10.1177/21514593251413152. Acesso em: 8 ago. 2026.
TODD, Knox H. A review of current and emerging approaches to pain management in the emergency department. Pain and Therapy, v. 6, n. 2, p. 193-202, 2017. Disponível em: https://doi.org/10.1007/s40122-017-0090-5. Acesso em: 8 ago. 2026.
TUCKER, Ryan; PETERSON, William; MINK, Jennifer; et al. Defining an ultrasound-guided regional anesthesia curriculum for emergency medicine. AEM Education and Training, v. 5, n. 2, e10557, 2020. Disponível em: https://doi.org/10.1002/aet2.10557. Acesso em: 8 ago. 2026.
WEINBERG, Guy; RIOU, Bruno. Lipid emulsion infusion. Anesthesiology, v. 117, n. 1, p. 180-187, 2012. Disponível em: https://doi.org/10.1097/aln.0b013e31825ad8de. Acesso em: 8 ago. 2026.
WHITSON, Micah R.; MAYO, Paul H. Ultrasonography in the emergency department. Critical Care, v. 20, n. 1, art. 227, 2016. Disponível em: https://doi.org/10.1186/s13054-016-1399-x. Acesso em: 8 ago. 2026.
WIERCIGROCH, David; BEN-YAKOV, Maxim; PORPLYCIA, Danielle; et al. Regional anesthesia in Canadian emergency departments: emergency physician practices, perspectives, and barriers to use. Canadian Journal of Emergency Medicine, v. 22, n. 5, p. 656-663, 2020. Disponível em: https://doi.org/10.1017/cem.2020.51. Acesso em: 8 ago. 2026.
WILSON, Casey; CHUNG, Kevin Kien Hoa; FONG, Tiffany. Challenges and variations in emergency medicine residency training of ultrasound-guided regional anesthesia techniques. AEM Education and Training, v. 1, n. 2, p. 120-125, 2016. Disponível em: https://doi.org/10.1002/aet2.10014. Acesso em: 8 ago. 2026.
