title: Reduced Length of Stay and Adverse Events Using Bier Block for Forearm Fracture Reduction in the Pediatric Emergency Department.
abstract: OBJECTIVE
  Forearm fractures are among the most common pediatric injuries. Procedural sedation is frequently used for analgesia during fracture reduction but requires a prolonged recovery period and can be associated with adverse events. Bier block is a safe alternative for fracture reduction analgesia. This study sought to compare Bier block and procedural sedation for forearm fracture reduction.
  
  
  METHODS
  We performed a retrospective study of patients aged 6 to 18 years, presenting with forearm fractures requiring closed reduction from June 2012 to March 2014. Outcomes assessed were emergency department length of stay, reduction success rates, adverse events, and unscheduled return visits.
  
  
  RESULTS
  Overall, 274 patients were included (Bier block, n = 109; procedural sedation, n = 165). Mean length of stay was 82 minutes shorter for Bier block patients (279 vs 361 minutes, P < 0.001). Subanalysis revealed a reduced length of stay among Bier block patients with forearm fractures involving a single bone (286 vs 388 minutes, P < 0.001) and both bones (259 vs 321 minutes, P < 0.05). Reduction success did not differ between Bier block and procedural sedation (98.2% vs 97.6%, P = 0.74). There were no major adverse events in either group, but Bier block patients experienced fewer minor adverse events (2.7% vs 14.5%, P < 0.001). Return visit rates were similar between Bier block and procedural sedation (17.6% vs 16.9%, P = 0.92).
  
  
  CONCLUSIONS
  Compared with procedural sedation, forearm fracture reduction performed with Bier block was associated with a reduced emergency department length of stay and fewer adverse events, with no differences in reduction success or return visits.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Fauteux-Lamarre
authors.forename: Brett
authors.initials: B
authors.lastname: Burstein
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.forename: Adam
authors.initials: A
authors.lastname: Bretholz
mesh_terms: D000293:Adolescent; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005543:Forearm Injuries / Q000628:therapy*; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D059408:Pain Management / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local