Regional anaesthesia worked well for children with femoral shaft fractures
Date First Published:
March 1, 2000
Last Updated:
November 1, 2002
Report by:
Rob Williams, SpR in Emergency Medicine (North Manchester General Hospital)
Search checked by:
Paul Wallman, North Manchester General Hospital
Three-Part Question:
In [children with femoral shaft fractures] is [femoral nerve block] effective in [reducing pain and distress and reducing the need for supplemental analgesia]?
Clinical Scenario:
A 6 year old child presents to the Emergency department with an undisplaced fracture of the mid femur. You have used femoral nerve blocks in adult patients with similar fractures and wonder whether this block is useful in children.
Search Strategy:
Medline 1966-03/00 using the OVID interface.
Search Details:
[({exp femur OR femur.mp OR femoral.mp} AND {exp fractures OR exp fractures,closed OR exp fractures, open OR fracture$.mp}) OR exp femoral fractures OR femoral fracture$.mp] AND {exp anesthesia, local OR local anesthesi$ OR exp nerve block OR regional anesthetic.mp OR nerve block.mp OR femoral block.mp} LIMIT to human AND english.
Outcome:
39 papers found of which 36 were irrelevant or of insufficient quality. The remaining 3 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Femoral nerve block for fractured shaft of femur. Tondare AS and Nadkarni AV. 1982 India. | 25 patients with fractured shaft of femur aged 5 - 35 years. Lignocaine blocks Subjective and objective measures of pain before and after the block. | Observational. | Need for supplemenntal analgesia | 5 of 25 | Not controlled. Pain scores not reported. No statistical analysis. |
| Pain | Reduced | ||||
| Femoral nerve block in the initial management of femoral shaft fractures. McGlone R, Sadhra K, Hamer DW, Pritty PE. 1987 UK. | 27 consecutive patients with femoral shaft fractures. 3 children. Lignocaine blocks.Pain assessed pre and post block. | Observational. | Pain score | Falls noted | Not controlled. No statistical analysis. |
| Femoral nerve blockade in children using bupivacaine. Ronchi L, Rosenbaum D, Athouel A, et al. 1989 France. | 14 children with fractures of the femoral shaft aged 2 - 10 years. Bupivicaine blocks. Pain assessed pre and post block. | Observational. | Need for supplemental analgesia | None in 13 of 14 children | Not controlled. No statistical analysis. |
| Pain scale | Marked falls in 13 of 14 children | ||||
| Time to onset of pain | 8 +/- 3.5 min |
Author Commentary:
None of the studies are of high quality in that none had a control group. Nevertheless the evidence suggests that femoral nerve block is effective in children.
Bottom Line:
Femoral nerve block is effective in reducing the pain of femoral shaft fractures in children.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Tondare AS and Nadkarni AV.. Femoral nerve block for fractured shaft of femur.
- McGlone R, Sadhra K, Hamer DW, Pritty PE.. Femoral nerve block in the initial management of femoral shaft fractures.
- Ronchi L, Rosenbaum D, Athouel A, et al.. Femoral nerve blockade in children using bupivacaine.