From the Denver Health Residency in Emergency Medicine, Denver Health Medical Center, Denver.
Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO.
Pediatr Emerg Care. 2023 Feb 1;39(2):e30-e34. doi: 10.1097/PEC.0000000000002607. Epub 2022 Jan 12.
Femur fractures are painful, and use of systemic opioids and other sedatives can be dangerous in pediatric patients. The fascia iliaca compartment nerve block and femoral nerve block are regional anesthesia techniques to provide analgesia by anesthetizing the femoral nerve. They are widely used in adult patients and are associated with good effect and reduced opioid use. Ultrasound (US) guidance of nerve blocks can increase their safety and efficacy. We sought to report on the use and safety of US-guided regional anesthesia of the femoral nerve performed by emergency physicians for femur fractures in 6 pediatric emergency departments.
Records were queried at 6 pediatric EDs across North America to identify patients with femur fractures managed with US-guided regional anesthesia of the femoral nerve between January 1, 2016, and May 1, 2021. Data were abstracted regarding demographics, injury pattern, nerve block technique, and analgesic use before and after nerve block.
Eighty-five cases were identified. Median age was 5 years (interquartile range, 2-9 years). Most patients were male and had sustained blunt trauma (59% low-mechanism falls). Ninety-four percent of injuries were managed operatively. Most patients (79%) received intravenous opioid analgesia before their nerve block. Ropivacaine was the most common local anesthetic used (69% of blocks). No procedural complications or adverse effects were identified.
Ultrasound-guided regional anesthesia of the femoral nerve is widely performed and can be performed safely on pediatric patients by emergency physicians and trainees in the pediatric emergency department.
股骨干骨折会引起疼痛，且在儿科患者中使用全身性阿片类药物和其他镇静剂可能存在危险。股神经的髂筋膜间隙神经阻滞和股神经阻滞是两种区域麻醉技术，通过麻醉股神经来提供镇痛。这些技术在成年患者中应用广泛，效果良好，且阿片类药物的使用量减少。神经阻滞的超声（US）引导可以提高其安全性和有效性。我们旨在报告北美 6 家儿科急诊部的急诊医师使用超声引导的股神经区域麻醉治疗股骨干骨折的情况，并评估其安全性。
我们在北美 6 家儿科急诊部的记录中查询了 2016 年 1 月 1 日至 2021 年 5 月 1 日期间接受超声引导的股神经区域麻醉治疗股骨干骨折的患者。数据包括患者的人口统计学、损伤模式、神经阻滞技术以及神经阻滞前后的镇痛药物使用情况。
共确定了 85 例病例。中位年龄为 5 岁（四分位距，2-9 岁）。大多数患者为男性，且遭受钝器伤（59%为低机械力坠落伤）。94%的损伤需要手术治疗。大多数患者（79%）在神经阻滞前接受了静脉内阿片类药物镇痛。罗哌卡因是最常用的局部麻醉剂（69%的阻滞）。未发现任何操作相关并发症或不良反应。
超声引导的股神经区域麻醉在儿科急诊部中广泛应用，由急诊医师和住院医师实施是安全可行的。
