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Fascia Iliaca Compartment Nerve Block Versus Systemic Pain Control for Acute Femur Fractures in the Pediatric Emergency Department

Neubrand, Tara L. MD; Roswell, Kelley MD; Deakyne, Sara MPH; Kocher, Kendra BA; Wathen, Joseph MD

doi: 10.1097/PEC.0000000000000163
Original Articles

Objective 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.

Methods 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.

Results 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.

Conclusions 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.

From the Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

Disclosure: The authors declare no conflict of interest.

Reprints: Tara L. Neubrand, MD, Children’s Hospital Colorado, 13123 E 16th Ave, Box 251, Aurora, CO 80045 (e-mail: tara.neubrand@childrenscolorado.org).

Abstract presented at the Pediatric Academic Societies’ Annual Meeting, April 28 to May 1, 2012, in Boston, MA.

© 2014 Lippincott Williams & Wilkins, Inc.