Pain relief is fundamental to compassionate, patient-centred emergency care, and getting it right can make a significant difference to a patient’s experience and recovery. While Bier blocks have long been the go-to regional anaesthetic for upper limb fracture reductions, emergency clinicians are increasingly exploring newer options, such as UGSCB.
Led by Dr Henry Tsao at Redland Hospital, the SUPERB Trial recruited 78 adult patients with wrist or forearm fractures that required manual realignment. Participants were randomly assigned to receive either UGSCB or BB, administered by emergency physicians trained in the techniques.
Dr Tsao recalled first encountering the UGSCB as a senior house officer, treating a patient with a traumatic elbow dislocation.
“I was immediately impressed by its potential. Later, as a consultant, I realised the evidence supporting its effectiveness was almost exclusively done by anaesthetists in the operating theatre – and that’s what inspired the SUPERB trial.”
The results, published in Emergency Medicine Australasia, confirmed that UGSCB was as effective as BB for procedural pain relief, with patients reporting very low pain scores. Patients receiving UGSCB reported significantly lower pain scores one hour after the procedure.
Both techniques had high patient satisfaction, similar lengths of stay in the ED, and low rates of minor adverse events, supporting UGSCB as a safe and effective option, particularly when BB or procedural sedation are not suitable or feasible.
Changing PracticeReflecting on the research’s impact, Dr Tsao shared that, “because UGSCB was performed with long-acting local anaesthetic, patients experienced pain relief for up to 12 hours. Many patients told us this was one of the best aspects of the block. For some, it meant that they could get a good night’s sleep.”
The SUPERB Trial has influenced local clinical guidelines and increased UGSCB use at Redland ED. The study was presented at the 2024 ACEM Annual Scientific Meeting, where it was nominated for Best Paper, and at Metro South Health Bayside Research Symposium.
The trial has also sparked broader interest in UGSCB, and future research will explore its real-world application across different emergency settings, including evaluations of safety and cost-effectiveness.
Dr Tsao explained that emergency physicians already use ultrasound-guided regional blocks for hip and rib fractures.
“Findings from the SUPERB trial further support advancing ultrasound-guided regional anaesthetic blocks – including UGSCB – as an accepted standard of care, or at least a viable strong alternative in the emergency setting. This also paves the way for future research.”
Dr Tsao’s work has not only improved care options but has also inspired a growing research culture at Redland ED, with several colleagues now applying for EMF Emerge grants to pursue their own clinician-led projects.