上肢骨折的比尔阻滞区域麻醉与石膏固定：儿科急诊科环境下的安全性

Bier block regional anesthesia and casting for forearm fractures: safety in the pediatric emergency department setting.

作者信息

Aarons Chad E, Fernandez Meagan D, Willsey Matt, Peterson Bret, Key Charles, Fabregas Jorge

机构信息

*Tuckahoe Orthopaedic Associates, Richmond, VA †Department of Orthopaedics, Geisinger Medical Center, Danville, PA ‡Department of Orthopaedic Surgery, SUNY Upstate Medical University, Syracuse, NY §Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC ∥Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA ¶Children's Orthopaedics of Atlanta, Atlanta, GA.

出版信息

J Pediatr Orthop. 2014 Jan;34(1):45-9. doi: 10.1097/BPO.0b013e31829fff47.

DOI:10.1097/BPO.0b013e31829fff47

PMID:24327166

Abstract

BACKGROUND

Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures.

METHODS

A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed.

RESULTS

A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956.

CONCLUSIONS

Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major complications.

LEVELS OF EVIDENCE

Level III--retrospective review.

摘要

背景

静脉区域麻醉于1908年首次被描述；然而，由于担心心脏和神经并发症，其使用并不常见。尽管最近的研究已证明在成人中使用是安全的，但迄今为止尚无研究调查其在儿科中的应用。此外，大多数急诊科认为，在小儿急性前臂骨折复位后，夹板固定比石膏固定更安全。然而，据我们所知，尚无研究记录与立即应用石膏相关的并发症发生率。本研究的目的是评估静脉区域麻醉和小儿前臂骨折闭合复位后立即应用石膏的安全性和有效性。

方法

对一家大型都市儿科医院在两年内治疗的前臂骨折患者进行回顾性研究。分析了两种治疗方法的并发症发生率、治疗时间和费用。

结果

在为期两年的研究期间，共有600例患者接受了静脉区域麻醉治疗前臂骨折，645例患者接受了清醒镇静治疗。两组均未出现需要住院治疗的并发症。没有患者发生骨筋膜室综合征或因应用石膏而需要再次入院。静脉区域麻醉组和镇静组分别有2.2%和4.3%（P = 0.0382）的患者因肿胀需要将石膏切开。从开始程序性镇静到出院的平均时间为1小时42分钟，而从开始静脉区域麻醉到出院的时间为47分钟（P < 0.0001）。接受程序性镇静治疗的患者平均费用为6313美元，而静脉区域麻醉组的平均费用为4956美元。