Closed reduction of paediatric forearm fractures: nitrous oxide versus general anaesthetic

Nitrous oxide with intranasal fentanyl is safe and effective in performing closed reduction of paediatric forearm fractures; however, the difference in outcome when compared to those performed under general anaesthesia (GA) is unclear. We aim to compare the outcomes of closed reduction of paediatric forearm fractures under nitrous oxide versus GA.

This retrospective study based on a prospective change in protocol reviewed the medical records and radiographs of patients with forearm fractures who presented to a tertiary paediatric centre, and who subsequently underwent closed reduction under either nitrous or GA. Data on patient demographics, type and site of fracture and the method of casting were collected. The primary outcomes were loss of reduction, the need for repeat intervention and the rate of complications.

There were 301 and 362 patients in the nitrous and GA groups respectively. The overall re-intervention rate was 7.6% in the nitrous group versus 5.0% in the GA group (P = 0.155). There was no significant difference in loss of reduction which involved 9.0% in the nitrous group and 11.3% in the GA group (P = 0.320). There was no significance difference in overall complications. Nausea and vomiting comprised the majority of adverse events.

Closed reduction of paediatric forearm fractures performed under nitrous oxide with intranasal fentanyl is safe, effective and achieves comparable re-intervention rates and adverse events to those performed under GA in the operating theatre.