A Comparison of Pediatric Forearm Fracture Reduction Between Conscious Sedation and General Anesthesia

Abstract

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Closed reduction of paediatric forearm fractures: nitrous oxide versus general anaesthetic

“…In our population, we have demonstrated a 7.6% versus 5.0% rate of re-intervention in the nitrous and GA groups, respectively (P = 0.155). Even with this in mind, we did not replicate the findings of the smaller study of McKenna et al 10 where re-intervention was 32% in the conscious sedation group compared to 11% in the GA group. It is important to note that re-intervention is a subjective measure, as different surgeons may have differing thresholds to re-intervene.…”

“…We have reported the loss of position as a secondary objective measurement, and also found no significant difference between the two groups. No objective outcome measures were presented by McKenna et al 10 As our sample size is 10 times larger, we can effectively refute the adverse findings of McKenna et al 10 Had we found the same rate of reintervention in our study we would need to review whether reduction in the ED was indicated.…”

“…The ability to perform a closed reduction of forearm fractures under sedation, such as nitrous oxide, in the ED is well established, safe and effective. [7][8][9][10] Kurien et al 11 reported a 90% success rate of closed reduction of forearm fractures in the ED without the need for admission to hospital.…”

“…2 There is limited literature available comparing the outcomes of closed reduction under conscious sedation in the ED compared to under general anaesthetic in the operating theatre. McKenna et al 10 compared 28 forearm fractures reduced under conscious sedation to 27 under GA. They found a significantly higher rate of re-intervention in the conscious sedation group (32%) compared to the GA group (11%).…”

Management of Pain in the Emergency Department

“…Based upon the recent literature, N 2 O may be poised for something of a comeback in the acute care setting [80,155,156,[164][165][166][167]. The agent is well known, self-administered, safe, and at least moderately effective.…”