Ultrasound-Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi-Center...

Managing pain associated with pediatric femur fractures is challenging. The ultrasound-guided fascia iliaca compartment nerve block (FICNB) provides regional analgesia for femur fractures in adults, but data on its effectiveness when provided by pediatric emergency medicine (PEM) physicians for children in the emergency department (ED) is limited.

This multi-center, prospective, observational study enrolled children aged 4-17 years who presented to the ED with an isolated, acute femur fracture. Participants received either a FICNB performed by a PEM physician or systemic analgesia alone, determined by each site's routine practice. Participants self-reported pain intensity using the Faces Pain Scale-Revised (0-10 continuous) at baseline, 60 min, and 240 min post-enrollment. The primary outcome was the mean difference in pain score reduction at 60 min compared to baseline between the two groups. Secondary outcomes included the mean difference in pain score at 240 min, opioid use, and adverse events.

Across 12 sites 114 participants were enrolled, and 54 received the FICNB. The groups had similar baseline characteristics. The FICNB group had a larger reduction in pain score compared to the No-FICNB group at 60 min (mean 3.8 vs. 0.8, difference between groups 3.0 [95% CI, 1.7 to 4.3]) and 240 min (mean 3.6 vs. 1.7, difference between groups 1.9 [95% CI, 0.5 to 3.2]). The FICNB group used 73% fewer oral morphine equivalents per hour (0.3 vs. 1.1, difference between groups 0.8 [95% CI, 0.4 to 1.1]). There were no significant adverse events in either group.

Children who received a FICNB appeared to have a greater reduction in pain intensity and required less opioid medication than those who did not. This is the largest prospective study evaluating the ultrasound-guided FICNB performed on children in the ED, and its findings support the procedure's use for pediatric femur fracture pain management.

Clinicaltrials.gov (NCT05947292, https://clinicaltrials.gov/study/NCT05947292).