{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:09:29Z","timestamp":1783350569269,"version":"3.54.6"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ultrasound\u2010guided nerve blocks (UGNBs) are a core component of multimodal analgesia for acute pain management in emergency departments (EDs). In addition to using standard local anesthetics, adjuncts have been demonstrated to extend the duration of UGNBs. We evaluated the efficacy and safety of dexamethasone and epinephrine as anesthetic adjuncts in UGNBs in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were analyzed from the National Ultrasound\u2010guided neRVE (NURVE) Block Registry, a retrospective, multicenter, observational registry evaluating UGNBs performed in 11 EDs from January 1, 2022, to December 31, 2023. A generalized linear mixed effects model (GLMER) with a binomial family examined factors associated with pain reduction when comparing adjunct vs. non\u2010adjunct UGNBs. The dependent variable and primary outcome were pain reduction. Secondary outcomes included safety, dosing of adjuncts, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 29.6% (812\/2742) of UGNBs received adjuncts, most commonly dexamethasone (72.5%, 589\/812) and epinephrine (23.5%, 191\/812). Dexamethasone had a 1.99 odds ratio of &gt;\u200950% pain reduction versus isolated local anesthetic blocks, while epinephrine had an odds ratio of 0.99 for &gt;\u200950% pain reduction. There was no association between adjunct use and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared to isolated local anesthetic nerve blocks, dexamethasone had an association with improved pain control within 60\u2009min; without additional safety concerns in a large retrospective dataset. Prospective studies are needed to further investigate these findings in the ED setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70128","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:50:48Z","timestamp":1756363848000},"page":"1299-1308","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Efficacy and Safety of Adjunct Medications in\n                    <scp>ED<\/scp>\n                    Ultrasound\u2010Guided Nerve Blocks: A National Ultrasound\u2010Guided\n                    <scp>NeRVE<\/scp>\n                    (\n                    <scp>NURVE<\/scp>\n                    ) Block Registry Study"],"prefix":"10.1111","volume":"32","author":[{"given":"Joseph","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Milgrim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Denver Health Medical Center University of Colorado  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6549-7386","authenticated-orcid":false,"given":"Lachlan","family":"Driver","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harvard Medical School Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Department of Emergency Medicine, Harvard Medical School Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6074-8315","authenticated-orcid":false,"given":"Melissa A.","family":"Meeker","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harvard Medical School Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhu\u2010Nguyen","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Denver Health Medical Center University of Colorado  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Nagdev","sequence":"additional","affiliation":[{"name":"Highland Hospital  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M.","family":"Duggan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harvard Medical School Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2223-621X","authenticated-orcid":false,"given":"David","family":"Martin","sequence":"additional","affiliation":[{"name":"Highland Hospital  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0065-3370","authenticated-orcid":false,"given":"Michael","family":"Heffler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-3594","authenticated-orcid":false,"given":"Hamid","family":"Shokoohi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harvard Medical School Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dreyfuss","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hennepin County Medical Center  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4674-2902","authenticated-orcid":false,"given":"Leland","family":"Perice","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brown Emergency Medicine  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Loma Linda University  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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