ORIGINAL ARTICLE
Impact of Ultrasound-Guided Femoral Nerve Blocks in the Pediatric Emergency Department Alyssa L. Turner, MD, Michelle D. Stevenson, MD, MS, and Keith P. Cross, MD, MS, MSc
Objective: The objective of this study was to compare the duration of analgesia, need for analgesic medications, and pain-related nursing interventions in patients who did and did not receive ultrasound-guided femoral nerve blocks for femur fracture pain. Methods: This is a retrospective, preimplementation and postimplementation cohort study. An emergency department log of patients receiving femoral nerve blocks for femur fracture pain was compared with a similar cohort of patients with femur fractures who did not receive nerve blocks. The primary outcome is time from initial pain treatment until the next dose of analgesic. Data were analyzed using Kaplan-Meier methods. Secondary outcomes include number of doses of pain medication, total amount of morphine given, and number of pain-related nursing interventions. Data were analyzed with the Mann-Whitney U test. Results: Eighty-one patients met inclusion/exclusion criteria: 50 in the preimplementation cohort and 31 in the postimplementation group. The median times until next dose of analgesic medication were 2.2 hours (interquartile range [IQR], 1.2Y3.4 hours) in the preimplementation group and 6.1 hours (IQR, 3.8Y9.5 hours) in the postimplementation group (P G 0.001). The median numbers of doses of pain medication were 0.3 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.07Y0.3 per hour) in the postimplementation group. The median total doses of morphine were 14.8 Hg/kg per hour (IQR, 9.4Y19.2 Hg/kg per hour) in the preimplementation group and 6.5 Hg/kg per hour (IQR, 0Y12.2 Hg/kg per hour) in the postimplementation group (P = 0.01). The median numbers of nursing interventions were 0.4 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.1Y0.2 per hour) in the postimplementation group (P G 0.001). Conclusions: Patients who received ultrasound-guided femoral nerve block for femur fracture pain had longer duration of analgesia, required fewer doses of analgesic medications, and needed fewer nursing interventions than those receiving systemic analgesic medication alone.
In July 2009, the use of ultrasound-guided femoral nerve block (UGFNB) was implemented in the emergency department (ED) of our urban tertiary care children’s hospital for the treatment of thigh pain in patients with femur fractures. To our knowledge, there is no literature describing the impact of ultrasound-guided femoral nerve blockade on duration of analgesia or pain medication requirements in pediatric patients with femur fractures. This study sought to determine if the use of UGFNB in the pediatric ED significantly altered the duration of analgesia and the need for pain medication in patients with femur fractures. Our hypothesis was that when compared with systemic pain control methods, UGFNB leads to longer duration of analgesia and reduced need for pain medication among patients with femur fractures.
METHODS Study Design
Key Words: femur fracture, ultrasound guidance, femoral nerve block, pain
This was a retrospective preimplementation and postimplementation cohort study of patients treated for femur fractures in a pediatric ED from July 2008 through July 2010. It was reviewed and approved by the University of Louisville institutional review board. The preimplementation cohort was identified using International Classification of Diseases, Ninth Revision codes for femur fracture in patients treated in the ED from July 2008 to June 2009. Patients in the postimplementation cohort were identified from a log of patients treated in the same ED from July 2009 until July 2010 who received femoral nerve blocks for femur fractures. Review of electronic medical records provided data for the analysis. Requirement of written informed consent was waived by the institutional review board. All femoral nerve blocks were performed using 0.5% ropivacaine at a dose of 0.5 to 1 mL/kg, maximum of 40 mL (80 mg).1
(Pediatr Emer Care 2014;30: 227Y229)
Study Setting and Population
F
emur fractures are often very painful injuries. Pain is transmitted primarily along the femoral nerve from the sensitive and spasming quadriceps muscle.1 Femoral nerve blockadeV injecting a local anesthetic around the femoral nerveVis one method for controlling pain in patients with femur fractures or anterior thigh injuries.2,3 Performing femoral nerve blocks with ultrasound guidance has been shown to provide an earlier, more complete block than using other techniques.4 From the Division of Emergency Medicine, Department of Pediatrics, Kosair Children’s Hospital, University of Louisville, Louisville, KY. Disclosure: The authors declare no conflict of interest. Reprints: Alyssa L. Turner, MD, Division of Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S Floyd St, Ste 300, Louisville, KY 40202 (e
Impact of Ultrasound-Guided Femoral Nerve Blocks in the Pediatric Emergency Department Alyssa L. Turner, MD, Michelle D. Stevenson, MD, MS, and Keith P. Cross, MD, MS, MSc
Objective: The objective of this study was to compare the duration of analgesia, need for analgesic medications, and pain-related nursing interventions in patients who did and did not receive ultrasound-guided femoral nerve blocks for femur fracture pain. Methods: This is a retrospective, preimplementation and postimplementation cohort study. An emergency department log of patients receiving femoral nerve blocks for femur fracture pain was compared with a similar cohort of patients with femur fractures who did not receive nerve blocks. The primary outcome is time from initial pain treatment until the next dose of analgesic. Data were analyzed using Kaplan-Meier methods. Secondary outcomes include number of doses of pain medication, total amount of morphine given, and number of pain-related nursing interventions. Data were analyzed with the Mann-Whitney U test. Results: Eighty-one patients met inclusion/exclusion criteria: 50 in the preimplementation cohort and 31 in the postimplementation group. The median times until next dose of analgesic medication were 2.2 hours (interquartile range [IQR], 1.2Y3.4 hours) in the preimplementation group and 6.1 hours (IQR, 3.8Y9.5 hours) in the postimplementation group (P G 0.001). The median numbers of doses of pain medication were 0.3 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.07Y0.3 per hour) in the postimplementation group. The median total doses of morphine were 14.8 Hg/kg per hour (IQR, 9.4Y19.2 Hg/kg per hour) in the preimplementation group and 6.5 Hg/kg per hour (IQR, 0Y12.2 Hg/kg per hour) in the postimplementation group (P = 0.01). The median numbers of nursing interventions were 0.4 per hour (IQR, 0.25Y0.5 per hour) in the preimplementation group and 0.15 per hour (IQR, 0.1Y0.2 per hour) in the postimplementation group (P G 0.001). Conclusions: Patients who received ultrasound-guided femoral nerve block for femur fracture pain had longer duration of analgesia, required fewer doses of analgesic medications, and needed fewer nursing interventions than those receiving systemic analgesic medication alone.
In July 2009, the use of ultrasound-guided femoral nerve block (UGFNB) was implemented in the emergency department (ED) of our urban tertiary care children’s hospital for the treatment of thigh pain in patients with femur fractures. To our knowledge, there is no literature describing the impact of ultrasound-guided femoral nerve blockade on duration of analgesia or pain medication requirements in pediatric patients with femur fractures. This study sought to determine if the use of UGFNB in the pediatric ED significantly altered the duration of analgesia and the need for pain medication in patients with femur fractures. Our hypothesis was that when compared with systemic pain control methods, UGFNB leads to longer duration of analgesia and reduced need for pain medication among patients with femur fractures.
METHODS Study Design
Key Words: femur fracture, ultrasound guidance, femoral nerve block, pain
This was a retrospective preimplementation and postimplementation cohort study of patients treated for femur fractures in a pediatric ED from July 2008 through July 2010. It was reviewed and approved by the University of Louisville institutional review board. The preimplementation cohort was identified using International Classification of Diseases, Ninth Revision codes for femur fracture in patients treated in the ED from July 2008 to June 2009. Patients in the postimplementation cohort were identified from a log of patients treated in the same ED from July 2009 until July 2010 who received femoral nerve blocks for femur fractures. Review of electronic medical records provided data for the analysis. Requirement of written informed consent was waived by the institutional review board. All femoral nerve blocks were performed using 0.5% ropivacaine at a dose of 0.5 to 1 mL/kg, maximum of 40 mL (80 mg).1
(Pediatr Emer Care 2014;30: 227Y229)
Study Setting and Population
F
emur fractures are often very painful injuries. Pain is transmitted primarily along the femoral nerve from the sensitive and spasming quadriceps muscle.1 Femoral nerve blockadeV injecting a local anesthetic around the femoral nerveVis one method for controlling pain in patients with femur fractures or anterior thigh injuries.2,3 Performing femoral nerve blocks with ultrasound guidance has been shown to provide an earlier, more complete block than using other techniques.4 From the Division of Emergency Medicine, Department of Pediatrics, Kosair Children’s Hospital, University of Louisville, Louisville, KY. Disclosure: The authors declare no conflict of interest. Reprints: Alyssa L. Turner, MD, Division of Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S Floyd St, Ste 300, Louisville, KY 40202 (e
