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Axillary Block for Analgesia During Manipulation of Forearm Fractures in the Pediatric Emergency Department A Prospective Randomized Comparative Trial

Kriwanek, Kelly L. MD*; Wan, Jim PhD†; Beaty, James H. MD‡; Pershad, Jay MD*

doi: 10.1097/01.bpo.0000229976.24307.30
Trauma: Original Article

Our objective was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary (brachial plexus) block regional anesthesia (20 children) or deep sedation with ketamine and midazolam (21 children). This was a prospective randomized unmasked controlled comparative trial conducted in an urban children's hospital emergency department. The 2 groups were similar in age (older than 8 years), fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. The primary outcome measure was procedural distress during manipulation as measured with the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The mean CHEOPS score was 6.4 ± 2.8 in the group with axillary block and 7.5 ± 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant (P = 0.126, 95% CI: 2.5, 0.3). Axillary block was used successfully in 18 (90%) of the 20 children. No patient in either group experienced any adverse events.

From the *Department of Pediatrics, Le Bonheur Children's Medical Center; †Department of Preventive Medicine, Division of Emergency Medicine, University of Tennessee Health Science Center; and ‡Pediatric Orthopaedics, University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery, Memphis, TN.

Reprints: Jay Pershad, MD, Le Bonheur Children's Medical Center, 50 N Dunlap St., Memphis, TN 38103. E-mail: pers2260@bellsouthnet.

© 2006 Lippincott Williams & Wilkins, Inc.