PMID- 37276083
OWN - NLM
STAT- MEDLINE
DCOM- 20240202
LR  - 20240206
IS  - 1535-1815 (Electronic)
IS  - 0749-5161 (Linking)
VI  - 40
IP  - 2
DP  - 2024 Feb 1
TI  - Regional Anesthesia as an Alternative to Procedural Sedation for Forearm Fracture 
      Reductions in the Pediatric Emergency Department.
PG  - 83-87
LID - 10.1097/PEC.0000000000002993 [doi]
AB  - BACKGROUND: Pediatric forearm fractures are common injuries in the pediatric 
      emergency department (PED). Pediatric procedural sedation (PPS) is often required 
      for forearm fracture reductions and pain control for casting. Bier blocks and 
      hematoma blocks are types of regional anesthesia (RA) procedures that can be 
      performed as a potential alternative to PPS. OBJECTIVE: The objective of this 
      study is to compare the safety of RA with that of PPS. We hypothesized that RA 
      has a safety profile that is equal or superior to PPS as well as a shorter 
      duration of treatment in the PED. METHODS: Pediatric emergency department 
      encounters in patients presenting with a diagnosis of radius fracture, ulna 
      fracture, distal "both-bone" fracture, Monteggia fracture, and/or Galeazzi 
      fracture were included. Outcomes of interest included patient adverse events 
      (AEs), sedation medications used, PED duration of treatment (arrival time to 
      disposition time), sedation failures, and reduction failures. RESULTS: Propensity 
      matching was performed resulting in 632 well-matched RA-PPS pairs. The PPS cohort 
      had 13% of encounters with at least 1 AE compared with 0.2% in the RA cohort, P < 
      0.001. The most common AE in the PPS group was hypoxia (9.8%), and the only AE in 
      the RA group was an intravenous infiltrate (0.16%). Within the matched cohorts, 
      PPS required more medications than RA (100% vs 60%, P < 0.001). Ketamine alone 
      was more commonly used in the PPS group than the RA group (86% vs 0.2%, P < 
      0.001). Propofol was used only in the PPS group. The average duration of 
      treatment was 205 (SD, 81) minutes in the PPS group and 178 (SD, 75) minutes in 
      the RA group ( P < 0.001). There were no reduction failures in either group. 
      CONCLUSIONS: Bier blocks and hematoma blocks are an acceptable alternative to PPS 
      for children requiring forearm reductions. The AE rate is low and the reduction 
      success rate is high. Duration of treatment in the PED is shorter for patients 
      receiving RA compared with PPS.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Sulton, Carmen D
AU  - Sulton CD
AD  - From the Division of Pediatric Emergency Medicine, Department of Pediatrics, 
      Children's Healthcare of Atlanta at Egleston, Emory University School of 
      Medicine, Atlanta, GA.
FAU - Fletcher, Nicholas
AU  - Fletcher N
AD  - Department of Orthopaedics, Center for Advanced Pediatrics, Emory University, 
      Atlanta, GA.
FAU - Murphy, Joshua
AU  - Murphy J
AD  - Children's Physician Group - Orthopaedics, Children's Healthcare of Atlanta, 
      Atlanta, GA.
FAU - Gillespie, Scott
AU  - Gillespie S
AD  - Division of Biostatistics, Emory University School of Medicine, Atlanta, GA.
FAU - Burger, Rebecca K
AU  - Burger RK
AD  - From the Division of Pediatric Emergency Medicine, Department of Pediatrics, 
      Children's Healthcare of Atlanta at Egleston, Emory University School of 
      Medicine, Atlanta, GA.
LA  - eng
PT  - Journal Article
DEP - 20230606
PL  - United States
TA  - Pediatr Emerg Care
JT  - Pediatric emergency care
JID - 8507560
SB  - IM
MH  - Humans
MH  - Child
MH  - Forearm
MH  - *Forearm Injuries/therapy
MH  - Fracture Fixation/methods
MH  - *Anesthesia, Conduction/methods
MH  - *Radius Fractures/therapy
MH  - Emergency Service, Hospital
MH  - Hematoma
MH  - Retrospective Studies
MH  - Conscious Sedation/methods
COIS- Disclosure: The authors declare no conflict of interest.
EDAT- 2023/06/05 19:10
MHDA- 2024/02/02 06:42
CRDT- 2023/06/05 12:33
PHST- 2024/02/02 06:42 [medline]
PHST- 2023/06/05 19:10 [pubmed]
PHST- 2023/06/05 12:33 [entrez]
AID - 00006565-990000000-00270 [pii]
AID - 10.1097/PEC.0000000000002993 [doi]
PST - ppublish
SO  - Pediatr Emerg Care. 2024 Feb 1;40(2):83-87. doi: 10.1097/PEC.0000000000002993. 
      Epub 2023 Jun 6.