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
{"title":"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","authors":"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","doi":"10.1111/acem.70084","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT05947292, https://clinicaltrials.gov/study/NCT05947292).</p>","PeriodicalId":7105,"journal":{"name":"Academic Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ultrasound-Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi-Center Study.\",\"authors\":\"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\",\"doi\":\"10.1111/acem.70084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT05947292, https://clinicaltrials.gov/study/NCT05947292).</p>\",\"PeriodicalId\":7105,\"journal\":{\"name\":\"Academic Emergency Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/acem.70084\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/acem.70084","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Ultrasound-Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi-Center Study.
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.
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.
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