Neubrand Tara L, Roswell Kelley, Deakyne Sara, Kocher Kendra, Wathen Joseph
From the Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Pediatr Emerg Care. 2014 Jul;30(7):469-73. doi: 10.1097/PEC.0000000000000163.
To compare management of acute femur fractures in children who received a fascia iliaca compartment nerve block (FICNB) to those who received systemic intravenously administered analgesics in the pediatric emergency department. The comparison evaluated frequency of use, effectiveness, and associated adverse event profiles.
Study population was derived from a retrospective chart review of pediatric patients sustaining acute femur fractures between 2005 and 2009. Cases (received FICNB) were compared with controls (only systemic analgesia) in terms of effectiveness and adverse event. Outcomes included total doses of systemic medications received and comparison of preintervention and postintervention pain scores.
Two hundred fifty-nine charts were reviewed: 158 who received FICNB versus 101 who did not. The median dose of systemic medications was 1 dose lower in the FICNB group compared with the systemic medications group. This remained significant after controlling for age and preintervention pain scores (P = 0.02). Median postintervention pain scores in the FICNB group were 1.5 points lower than those in the systemic medications group. This remained significant while controlling for preintervention pain scores and age (P < 0.01). There was no difference in the total adverse events between the FICNB and the control group in either the unadjusted or adjusted analyses (P = 0.08). The FICNB group had 2 seizure episodes, one of which had associated subarachnoid hemorrhage. No patient in either group experienced bradycardia, arrhythmia, visual disturbance, abnormal hearing, mouth numbness, motor tremors, pain or bleeding at injection site, or prolonged nerve block.
We report on the largest number of FICNBs administered in a pediatric emergency department for acute femur fractures. Effectiveness, as measured by pain scores and total doses of systemic analgesia, was improved in the FICNB group versus the control. There was no difference in adverse events between the groups.
比较在儿科急诊科接受髂筋膜室神经阻滞（FICNB）的儿童急性股骨骨折的管理与接受全身性静脉注射镇痛药的儿童的管理。该比较评估了使用频率、有效性和相关不良事件概况。
研究人群来自对2005年至2009年间发生急性股骨骨折的儿科患者的回顾性病历审查。就有效性和不良事件而言，将病例组（接受FICNB）与对照组（仅接受全身性镇痛）进行比较。结果包括接受的全身性药物的总剂量以及干预前和干预后疼痛评分的比较。
共审查了259份病历：158例接受了FICNB，101例未接受。与全身性药物组相比，FICNB组全身性药物的中位剂量低1剂。在控制年龄和干预前疼痛评分后，这一差异仍然显著（P = 0.02）。FICNB组干预后的中位疼痛评分比全身性药物组低1.5分。在控制干预前疼痛评分和年龄时，这一差异仍然显著（P < 0.01）。在未调整或调整分析中，FICNB组和对照组之间的总不良事件没有差异（P = 0.08）。FICNB组有2例癫痫发作，其中1例伴有蛛网膜下腔出血。两组均无患者出现心动过缓、心律失常、视觉障碍、听力异常、口腔麻木、运动震颤、注射部位疼痛或出血或神经阻滞延长。
我们报告了儿科急诊科针对急性股骨骨折给予FICNB的最大数量。与对照组相比，FICNB组在疼痛评分和全身性镇痛总剂量方面的有效性有所提高。两组之间的不良事件没有差异。
