Ultrasound-Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi-Center Study.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-06-17 DOI:10.1111/acem.70084

Zachary W Binder, Carrie Ng, Nicole Klekowski, Simone L Lawson, Antonio Riera, Amanda Greene Toney, Kathryn H Pade, Tama Saint The, Ashkon Shaahinfar, Lindsey T Chaudoin, Emily Lauer, Peter J Snelling, Matthew M Moake

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引用次数: 0

Abstract

Background: Managing pain associated with pediatric femur fractures is challenging. The ultrasound-guided fascia iliaca compartment nerve block (FICNB) provides regional analgesia for femur fractures in adults, but data on its effectiveness when provided by pediatric emergency medicine (PEM) physicians for children in the emergency department (ED) is limited.

Methods: This multi-center, prospective, observational study enrolled children aged 4-17 years who presented to the ED with an isolated, acute femur fracture. Participants received either a FICNB performed by a PEM physician or systemic analgesia alone, determined by each site's routine practice. Participants self-reported pain intensity using the Faces Pain Scale-Revised (0-10 continuous) at baseline, 60 min, and 240 min post-enrollment. The primary outcome was the mean difference in pain score reduction at 60 min compared to baseline between the two groups. Secondary outcomes included the mean difference in pain score at 240 min, opioid use, and adverse events.

Results: Across 12 sites 114 participants were enrolled, and 54 received the FICNB. The groups had similar baseline characteristics. The FICNB group had a larger reduction in pain score compared to the No-FICNB group at 60 min (mean 3.8 vs. 0.8, difference between groups 3.0 [95% CI, 1.7 to 4.3]) and 240 min (mean 3.6 vs. 1.7, difference between groups 1.9 [95% CI, 0.5 to 3.2]). The FICNB group used 73% fewer oral morphine equivalents per hour (0.3 vs. 1.1, difference between groups 0.8 [95% CI, 0.4 to 1.1]). There were no significant adverse events in either group.

Conclusions: Children who received a FICNB appeared to have a greater reduction in pain intensity and required less opioid medication than those who did not. This is the largest prospective study evaluating the ultrasound-guided FICNB performed on children in the ED, and its findings support the procedure's use for pediatric femur fracture pain management.

Trial registration: Clinicaltrials.gov (NCT05947292, https://clinicaltrials.gov/study/NCT05947292).

查看原文本刊更多论文

超声引导神经阻滞治疗急诊科儿童股骨骨折：一项前瞻性多中心研究

背景：处理与儿童股骨骨折相关的疼痛是具有挑战性的。超声引导的筋膜髂隔室神经阻滞（FICNB）为成人股骨骨折提供了局部镇痛，但儿科急诊医学（PEM）医生在急诊科（ED）为儿童提供的有效性数据有限。方法：这项多中心、前瞻性、观察性研究招募了4-17岁的儿童，他们向急诊科报告了孤立的急性股骨骨折。参与者接受由PEM医师执行的FICNB或单独的全身镇痛，由每个部位的常规实践决定。参与者在基线、60分钟和入组后240分钟使用面部疼痛量表（0-10连续）自我报告疼痛强度。主要结局是两组在60分钟时疼痛评分与基线相比的平均差异。次要结局包括240分钟疼痛评分、阿片类药物使用和不良事件的平均差异。结果：在12个站点中，114名参与者被招募，54人接受了FICNB。两组的基线特征相似。与无FICNB组相比，FICNB组在60分钟（平均3.8比0.8,3.0组之间的差异[95% CI， 1.7至4.3]）和240分钟（平均3.6比1.7,1.9组之间的差异[95% CI， 0.5至3.2]）时疼痛评分降低幅度更大。FICNB组每小时口服吗啡当量减少73% （0.3 vs 1.1, 0.8组间差异[95% CI， 0.4 ~ 1.1]）。两组均无明显不良事件发生。结论：接受FICNB的儿童似乎比没有接受FICNB的儿童更能减轻疼痛强度，并且需要更少的阿片类药物。这是评估超声引导下FICNB在急诊科儿童中应用的最大的前瞻性研究，其研究结果支持该手术在儿童股骨骨折疼痛治疗中的应用。试验注册：Clinicaltrials.gov （NCT05947292, https://clinicaltrials.gov/study/NCT05947292）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.