INTRAVENOUS REGIONAL ANESTHESIA FOR MANAGEMENT OF CHILDRENS EXTREMITYFRACTURES IN THE EMERGENCY DEPARTMENT

Objective: To determine if intravenous regional anesthesia (Bier block ) is safe and efficacious for the management of children's extremity f ractures in the emergency department (ED). Design: Retrospective revie w of 470 ED records of children presenting with extremity fractures re duced with intravenous regional anesthesia from 1989 through 1994. Set ting: ED of a 256-bed teriary care children's hospital. Patients: Four hundred seventy children treated in the ED from 1989 through 1994 for extremity fractures reduced with Bier block anesthesia, Three hundred eleven boys and 159 girls with a mean age of 9.4 years (range two-19 years) were included in the review. Intervention: Utilization of intra venous regional anesthesia for fracture reduction of affected extremit y. Main outcome measures: ED records and orthopaedic consultation note s Here reviewed for adequacy of reduction, number of reduction attempt s, efficacy of anesthesia, and any associated untoward effects or comp lications, and review of operative notes of any children who required a subsequent procedure in the operating room (OR) under general anesth esia. Results: Ninety-nine percent (467) had adequate anesthesia for f racture reduction, There Here no complications noted, Specifically, th ere Here no incidents of hypotension, tachycardia, seizures, or arrhyt hmia, Bier block anesthesia was aborted in three patients because veno us access could not be obtained in the affected extremity. Less than 2 % (8) required a general anesthetic in the OR for Further treatment. A ll of the children taken to the OR underwent internal fixation of the fracture. Conclusions: Intravenous regional anesthesia (Bier block) is safe and efficacious in the treatment of children's extremity fractur es in the ED.