Exploring the Feasibility of Ultrasound-Guided Supraclavicular Nerve Blocks for Distal Forearm Fracture Management in Pediatric Patients.

BACKGROUND

Forearm fractures are a common presentation to the emergency department (ED), frequently requiring reduction and immobilization. In the pediatric population, procedural sedation (PS) is the gold standard to allow for appropriate analgesia, patient compliance, and ultimately successful reduction. When clinical or patient-specific factors limit PS, a possible alternative for analgesia to facilitate reduction of forearm fractures in the ED is ultrasound-guided nerve blocks. This is especially significant for the pediatric population, given that nonsurgical treatment is frequently the standard of care.

CASE SERIES: Illustrative case series of three pediatric patients who underwent supraclavicular brachial plexus nerve block for the management of distal forearm fracture at a tertiary hospital. The indication for supraclavicular nerve block was unique in all patients: avoiding PS to monitor the Glasgow coma scale, limiting doses of opioids for analgesia, and parental preference to avoid the risks of complications associated with PS. Each reduction was successful on the first attempt. There were no surgical interventions or adverse events in our patients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Supraclavicular nerve block can serve as a successful alternative to PS for reduction and analgesia without adverse events. It holds exceptional potential as an alternative to PS in a variety of clinical scenarios.