title: Fascia iliaca compartment nerve block versus systemic pain control for acute femur fractures in the pediatric emergency department.
abstract: 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.
authors: From the Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
authors: Tara L
authors: TL
authors: Neubrand
authors: Kelley
authors: K
authors: Roswell
authors: Sara
authors: S
authors: Deakyne
authors: Kendra
authors: K
authors: Kocher
authors: Joseph
authors: J
authors: Wathen
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005205:Fascia / Q000294:innervation; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D009407:Nerve Block / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000700:Analgesics