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Regional anaesthesia for femoral shaft fractures in children
  1. Rob Williams,
  2. Paul Wallman
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Rob Williams, Clinical Fellow Search checked by Paul Wallman, Clinical Fellow

    Clinical scenario

    A 6 year old child presents to the emergency department with an undisplaced fracture of the mid-femur. You have used femoral nerve blocks in adult patients with similar fractures and wonder whether this block is useful in children.

    Three part question

    In [children with femoral shaft fractures] is [femoral nerve block] effective in [reducing pain and distress and reducing the need for supplemental analgesia]?

    Search strategy

    Medline 1966–03/00 using the OVID interface. [({exp femur OR femur.mp OR femoral.mp} AND {exp fractures OR exp fractures,closed OR exp fractures, open OR fracture$.mp}) OR exp femoral fractures OR femoral fracture$.mp] AND {exp anesthesia, local OR local anesthesi$ OR exp nerve block OR regional anesthetic.mp OR nerve block.mp OR femoral block.mp} LIMIT to human AND english.

    Search outcome

    Altogether 39 papers were found of which 36 were irrelevant or of insufficient quality. The remaining three papers are shown in table 2.

    Table 2

    Comments

    None of the studies are of high quality in that none had a control group. Nevertheless the evidence suggests that femoral nerve block is effective in children.

    Clinical bottom line

    Femoral nerve block is effective in reducing the pain of femoral shaft fractures in children.

    Report by Rob Williams, Clinical Fellow Search checked by Paul Wallman, Clinical Fellow

    References

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