Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children.

OBJECTIVE

To evaluate the efficacy and safety of intravenous regional anesthesia in the treatment of unilateral closed fractures and dislocations of forearm or wrist in children.

DESIGN

A prospective study over 6 years.

SETTING

The study was undertaken in the well-equipped emergency department of a community general hospital for ambulatory patients.

PATIENTS

One hundred and thirty-nine children between the ages of 4 and 18 years with unilateral closed fractures and dislocations of forearm or wrist.

INTERVENTION

All children received premedication with a combination of meperidine and promethazine (0.5 mg/kg intramuscularly) and regional upper limb anesthesia with 0.5% lidocaine solution (3 mg/kg intravenously) after inflation of an arm tourniquet.

MAIN OUTCOME MEASURES

The relief of pain, allowing closed reduction with intravenous regional anesthesia, and the incidence of complications.

RESULTS

All patients had complete relief of pain allowing successful closed reduction in 133 patients (96%); tourniquet pain occurred in 10 patients (7%). There were no symptoms of lidocaine toxicity. There were no neurovascular or compartment syndrome complications.

CONCLUSIONS

Intravenous regional anesthesia for the treatment of fractures and dislocations of forearm and wrist in children was found to be simple, safe and effective.