Fran Lowry

November 01, 2011

November 1, 2011 (Boston, Massachusetts) — For children with painful femur fractures, nerve blocks performed with ultrasound guidance can significantly improve pain control while reducing adverse effects and nurses' workloads, researchers reported here at the American Academy of Pediatrics 2011 National Conference and Exhibition.

In children who received femoral nerve blocks that were guided by ultrasound, the interval between initial pain treatment and a subsequent dose of pain medication was 2 to 3 times longer than in children who did not receive a nerve block, Alyssa L. Turner, MD, from the University of Louisville, Kentucky, told meeting attendees.

This suggests a longer duration of analgesia than systemic analgesic medication, she said.

Dr. Keith Cross

Coauthor Keith P. Cross, MD, also from the University of Louisville, told Medscape Medical News that he and his colleagues were inspired to do this study after researchers at the Denver Children's Hospital in Colorado had some success with femoral nerve blocks for controlling the pain of femoral fractures (Ann Emerg Med. 2007;50:162-171).

"Joe Wathen and his group reported better pain control than with narcotics," Dr. Cross said. "We decided to start using femoral nerve blocks, but to improve on the safety and efficacy by adding ultrasound guidance where we actually watch the needle deliver the anesthetic right next to the nerve."

After doing these blocks with good results for a period of time, the group conducted a study to compare pain outcomes in patients the year before (n = 50) and the year after (n = 49) the implementation of ultrasound-guided femoral nerve blocks.

All patients were 1 to 17 years of age (average age, 6.5 years in the before group and 7.2 years in the after group) and presented within 24 hours of sustaining a femur fracture.

Patients in the before group received routine pain control, usually with intravenous morphine. The fracture types were similar in both groups, Dr. Cross said.

The team found that the mean time until the next dose of pain medication was 176 minutes (95% confidence interval [CI], 116 to 236) in the before group and 435 minutes (95% CI, 327 to 544) in the after group.

"We are continuing to analyze medication-related adverse events, pain scores, and resource utilization. For now, we are hopeful that this technique will improve pain control, particularly for children with these painful injuries," Dr. Cross said.

Dr. Cross has disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition: Abstract 14912. Presented October 14, 2011.

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