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Advances in Procedural Pain Management in Emergency Medicine

Last week, Maybritt Kuypers, a founding member of Outdoor Medicine, had the honor of defending her dissertation. The title of her dissertation is “Advances in Procedural Pain Management in Emergency Medicine.” Congratulations, Maybritt!

This is a very important milestone in her field. Procedural Sedation and Analgesia (PSA) in the emergency department is increasingly used for uncomfortable and painful procedures, both inside and outside the Netherlands. Implementing this procedure is a challenge in itself. A practical NVSHA guideline was already published in 2012 to complement the national CBO guideline, which Maybritt co-authored. Through a series of prospective observational cohort studies, Maybritt and her co-authors have convincingly demonstrated that PSA in the ED can be safely performed by EM physicians and EM residents, provided they have the proper training and follow the guidelines. Moreover, she has shown through cross-sectional studies that there is still much room for improvement in hospitals that do not employ EM physicians. Furthermore, she demonstrated through a systematic review and meta-analysis that peripheral nerve blocks are as effective as PSA, but that nerve blocks have fewer side effects and result in a shorter stay in the ER.

Finally, she conducted a randomized controlled trial – investigating the added value of a novel audio-video distraction tool in adults undergoing wrist fracture repositioning under local anesthesia in the emergency room. Although patients were enthusiastic about it, it had no additional effect on the patients’ pain or anxiety scores – compared to conventional therapy without these audio-visual distraction. More research is needed to explore the value for this type of new “distraction” technology in other emergency patient categories.

Maybritt’s doctoral research has made a valuable contribution to improving pain management in emergency medicine.