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

    http://dx.doi.org/10.1136/emj.17.4.283

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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.

      View this table:
      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

      1. Tondare A, Nadkarni AV. Femoral nerve block for fractured shaft of femur. Can Anaest Soc J1982;29:270–1.
        OpenUrl
      2. McGlone R, Sadhra K, Hamer DW, et al. Femoral nerve block in the initial management of femoral shaft fractures. Arch Emerg Med1987;4:163–8.
        OpenUrlPubMedWeb of Science
      3. Ronchi L, Rosenbaum D, Athouel A, et al. Femoral nerve blockade in children using bupivicaine. Anesthesiology1989;70:622–4.
        OpenUrlPubMedWeb of Science