Book excerpt: "This thesis describes the advances of procedural pain management in Emergency Medicine in the Netherlands. Emergency Physicians have played an instrumental role in the introduction of procedural sedation and analgesia (PSA) in the emergency department. In the first part of this thesis, the safety, efficacy, and costs of PSA performed by Emergency Physicians was assessed. This thesis demonstrates the capability of Emergency Physicians to perform safe and effective PSA in adult and pediatric patients. The presence of skilled Emergency Physicians has improved the quality, availability, and costs of advanced pain treatment in patients who need to undergo painful procedures, for example the reduction of a dislocated joint or fracture, in the emergency department. In the second part, the implementation of PSA was evaluated by assessing the skills of the providers, guideline adherence and availability of PSA in emergency departments staffed with or without Emergency Physicians. This research revealed that the availability of PSA, and adherence to PSA guidelines, was not up-to-par in the departments which had no Emergency Physicians on staff. In the last part of this thesis, new strategies for procedural pain management in the emergency department were explored. Peripheral nerve blocks performed by Emergency Physicians were compared to PSA on efficacy, safety, and length-of-stay in the emergency department. Nerve blocks appear to be a promising technique with the important advantage of a reduced length-of-stay in the emergency department. Finally, a novel audiovisual distraction tool was evaluated for use during wrist fracture reductions in adult emergency patients. A clear advantage on pain or anxiety reduction was not found. However, more research is needed to better assess its value in distinct emergency patient categories. In conclusion, Emergency Physicians have an important responsibility to ensure high-quality and safe analgesia in the emergency department. They also have the duty to keep pushing the frontier on pain management in Emergency Medicine with evidence-based research."--