Baker Mark D, Gullett John P
*Associate Professor of Pediatrics (Baker), Department of Pediatrics and †Associate Professor of Emergency Medicine, Co-Director of the Division of Emergency Ultrasound (Gullett), Department Emergency Medicine, University of Alabama - Birmingham, Birmingham, AL.
Pediatr Emerg Care. 2015 Dec;31(12):864-8; quiz 869-71. doi: 10.1097/PEC.0000000000000634.
Pediatric acute femur fractures are a relatively common major orthopedic injury seen in emergency departments. Providing adequate and safe analgesia is essential while patients await definitive management of these fractures. Opioid medications are typically used to treat fracture-associated pain but have well-known adverse effects including respiratory and central nervous system depression, pruritus, nausea, and allergic reactions. Dose titration of opioids in pediatric patients may be difficult and requires frequent nursing and physician reassessments. Regional anesthesia using ultrasound guidance has been proposed as a reliable and safe method to provide pain relief for this population and to decrease reliance on opioid medications. There is a growing body of literature on the utility and safety of ultrasound-guided femoral nerve blocks for pediatric patients in the acute care setting. This review article covers recent literature on point-of-care ultrasound-guided femoral nerve blocks for pediatric patients, with a discussion of the indications, sonographic anatomy, selection of anesthetics, nerve block technique, and complications. This review supplements the expert supervision and practice required to gain competency.
小儿急性股骨骨折是急诊科较为常见的严重骨科损伤。在患者等待这些骨折的确定性治疗期间，提供充分且安全的镇痛至关重要。阿片类药物通常用于治疗骨折相关疼痛，但具有包括呼吸和中枢神经系统抑制、瘙痒、恶心及过敏反应等众所周知的不良反应。小儿患者阿片类药物的剂量滴定可能困难，且需要护士和医生频繁重新评估。已提出使用超声引导的区域麻醉作为为该人群提供疼痛缓解并减少对阿片类药物依赖的可靠且安全的方法。关于急性护理环境中超声引导股神经阻滞用于小儿患者的效用和安全性的文献越来越多。这篇综述文章涵盖了近期关于床旁超声引导小儿患者股神经阻滞的文献，讨论了适应证、超声解剖、麻醉剂选择、神经阻滞技术及并发症。本综述补充了获得能力所需的专家监督和实践。
