Abstract
Painful upper extremity injuries frequently require procedures for which procedural sedation may be resource-intensive. This prospective study evaluated the educational impact and clinical feasibility of implementing a structured ultrasound-guided regional anesthesia curriculum as an alternative to procedural sedation for selected upper extremity procedures within a community emergency medicine residency. From January through December 2025, attending emergency physicians participated in a two-hour didactic session and hands-on workshop followed by longitudinal on-shift mentorship. Physician knowledge was assessed using a locally developed pre- and post-intervention cognitive assessment. Seventeen physicians completed the curriculum. Mean assessment scores increased from 8.18±3.05 to 18.41±1.58, with a mean improvement of 10.24 points (95% confidence interval (CI), 9.02-11.45; p<0.001). During clinical implementation, 30 ultrasound-guided brachial plexus blocks were performed. The intended procedure was completed without procedural sedation in 28 (93.3%) cases. In two (6.7%) cases, procedural sedation was subsequently required to complete the planned reduction. No immediate procedure-related complications were observed. A structured ultrasound-guided regional anesthesia curriculum was associated with improved physician knowledge and successful clinical implementation of brachial plexus blocks. These findings support the feasibility of incorporating ultrasound-guided regional anesthesia as an additional analgesic strategy for selected upper extremity procedures in a community emergency medicine setting.