Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department

Oron Frenkel, Otto Liebmann, Jason W Fischer
Pediatric Emergency Care 2015, 31 (4): 255-9

OBJECTIVES: Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

METHODS: We conducted a prospective nonblinded descriptive study of ultrasound-guided ulnar, median, and radial nerve blocks in a convenience sample of pediatric patients with hand injuries requiring procedural intervention who presented to a freestanding pediatric ED.

RESULTS: The mean initial pain score for the sample was 5.8, and the mean postprocedure score was 0.8, with a mean on the 10-point visual pain scale of 5 (interquartile range [IQR], 3-6; P = 0.04). Seven patients reported complete resolution of their pain that was signified by a score of 0. The mean time to completion for ulnar nerve block was 79 seconds (IQR, 67-103 seconds). The mean time to completion for median nerve block was 76 seconds (IQR, 70-112 seconds). The mean time to completion for radial nerve block was 69 seconds (IQR, 60-100 seconds). No immediate complications, including vascular puncture, carpal tunnel injury, or direct nerve injection, were noted during the study. At 1-year follow-up, no adverse effects were reported.

CONCLUSIONS: Ultrasound-guided forearm nerve blocks are effective for pediatric patients in the ED. The procedure provides effective analgesia and facilitates care while minimizing iatrogenic risk.

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