Ultrasound-Guided Regional Anesthesia of the Femoral Nerve in the Pediatric Emergency Department

Abstract

ObjectivesFemur 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.MethodsRecords 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.ResultsEighty-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.ConclusionsUltrasound-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.

Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

“…EDs are the frontline for painful procedures, and adult and pediatric emergency providers are often trained in ultrasound-guided peripheral nerve blocks to treat localized pain, often after injury. 52,53 Ultrasound guidance has made peripheral nerve blocks feasible, safe, and effective in ED. 54 As a result, there have been multiple case reports, 55 case series, 56,57 observational studies series, [58][59][60] and prospective randomized controlled trials 61 using peripheral nerve blocks in both adult and pediatric EDs for various painful clinical conditions.…”

“…Ultrasound guidance has made peripheral nerve blocks feasible, safe, and effective in ED 54 . As a result, there have been multiple case reports, 55 case series, 56,57 observational studies series, 58–60 and prospective randomized controlled trials 61 using peripheral nerve blocks in both adult and pediatric EDs for various painful clinical conditions 52,53 . The addition of procedural sedation with dexmedetomidine and/or subanesthetic doses of ketamine may be useful adjuncts for the regional anesthesia procedure, especially in pediatric patients.…”

“…Peripheral nerve blocks may be a feasible modality for pain control in patients with VOC in the ED. EDs are the frontline for painful procedures, and adult and pediatric emergency providers are often trained in ultrasound‐guided peripheral nerve blocks to treat localized pain, often after injury 52,53 . Ultrasound guidance has made peripheral nerve blocks feasible, safe, and effective in ED 54 .…”

Updates in pediatric ultrasound

“…The safety and effectiveness of nerve blocks have long been established in adult emergency medical care, and recent studies have demonstrated similar results in pediatric emergency medicine. A review of 85 pediatric patients receiving an ultrasound-guided nerve block for pain control associated with femur fractures by pediatric emergency providers found no adverse events, demonstrating that with adequate training and implementation, nerve blocks can be safely performed [49]. Ultrasound-guided nerve blocks have been shown to be safe and effective at pain control and even preferable to sedation.…”

Ultrasound-Guided Paravenous Saphenous Nerve Block for Lower Extremity Abscess Incision and Drainage in a Male Adolescent

“…The largest reported of these involves blockade of the femoral nerve via either a femoral nerve block or fascia iliaca compartment block. These blocks have been shown to be both safe and effective, allowing for improved pain and decreased systemic analgesic use when compared with systemic analgesia alone 15–19 . A recent prospective randomized controlled trial in 60 pediatric forearm fracture patients demonstrated decreased pain scores and increased parent and operator satisfaction with use of an infraclavicular brachial plexus block compared with procedural sedation 20 .…”