Rd. Blasier et R. White, INTRAVENOUS REGIONAL ANESTHESIA FOR MANAGEMENT OF CHILDRENS EXTREMITYFRACTURES IN THE EMERGENCY DEPARTMENT, Pediatric emergency care, 12(6), 1996, pp. 404-406
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.