1. ABDULLAH MUKHLEF JABR ALANAZI - Technician-Emergency Medical Services, National Guard Hospital.
2. MOHAMMED WASYUS GHALLAB ALHARBI - Paramedic Technician, National Guard Hospital.
3. RANA TALAL ALZAHRANI - Radiology Technologist, National Guard Hospital.
4. NADIM IBRAHIM ZAHID - Radiology Technologist, National Guard Hospital.
5. ABDULLAH MOHAMMED AL RIFDAH - Radiology Technologist, National Guard Hospital.
6. GHADEER ABDULLAH ALAJMI - Radiology Specialist, National Guard Hospital.
7. REEM HAMAD ALONAZI - Anesthesia Technician, National Guard Hospital.
8. AHMAD HAMAD ALENEZI - Anesthesia Technician, National Guard Hospital.
9. MESHAL ALI HADADI - Laboratory specialist, Laboratory Department, King Abdulaziz armed Forces Hospital Navel Base, Jubail, Saudi Arabia.
10. AHMED SALEH ALGHAMDI - Radiology Technologist I, National Guard Hospital.
Background: Imaging-guided regional anesthesia and sedation workflows are increasingly used in emergency departments (EDs) to improve anesthesia for painful conditions and procedures while supporting timely imaging, definitive intervention, and safe disposition. Objective: To synthesize evidence on radiology-guided anesthesia pathways in the ED (primarily ultrasound-guided regional anesthesia/nerve blocks and imaging-linked workflows) and their effects on time to procedure, adverse events, opioid requirements, and disposition-related outcomes (ED length of stay, admission patterns). Methods: A PRISMA-aligned systematic review was conducted in PubMed Central on December 28, 2025. Eligible studies were original human research conducted in ED settings evaluating imaging-guided anesthesia (ultrasound-guided nerve blocks integrated into ED care pathways), reporting at least one prespecified outcome (time metrics, adverse event, opioid use, ED and hospital LOS, disposition). Risk of bias was assessed using RoB 2 for randomized trials and the NIH observational tools for nonrandomized designs. Results: Eight eligible original studies were fully retrievable in PMC and included. In studies, ultrasound guided blocks were consistently feasible in ED workflow and were associated with clinically meaningful pain reduction and low complication rates, with several reports supporting reduced opioid exposure and/or reduced monitoring needs. Implementation studies suggested that standardized pathways and curricula increased nerve block use and may improve throughput measures. Disposition outcomes were variably reported and heterogeneous. Conclusion: In ED care pathways, radiology-guided regional anesthesia appears safe and effective, with signals for reduced opioid use and potential operational benefits. Evidence for consistent improvements in time-to-procedure and disposition endpoints is limited by heterogeneity and variable outcome reporting. Larger pragmatic trials and pathway-level evaluations with standardized operational endpoints are needed.
Emergency Department; Ultrasound-Guided Regional Anesthesia; Nerve Block; Procedural Workflow; Time To Procedure; Adverse Events; Disposition; Length Of Stay; Point Of Care Ultrasound.