Efficacy of Ultrasound-Guided Brachial Plexus Blocks Performed by Pediatric Emergency Physicians for the Reduction of Forearm Fractures: A Retrospective Cohort Study.

OBJECTIVES

Ultrasound-guided nerve blocks are commonly used in pediatric anesthesia and have excellent safety profiles. This study aims to compare outcomes of forearm fracture reductions that were performed using regional anesthesia with ultrasound-guided brachial plexus nerve blocks (UBPB) versus those performed using nitrous oxide (N 2 O) sedation with hematoma block or sedation with ketamine or propofol.

METHODS

This single-center retrospective cohort study included patients under 15 years of age who underwent closed forearm fracture reduction in a tertiary care pediatric emergency department from 2019 to 2024. Data were extracted from electronic health records and analyzed for demographic, clinical, and radiographic variables. The primary outcome was the association between sedation method and the likelihood of an unacceptable fracture reduction, adjusted for confounder variables.

RESULTS

Three hundred forty-one patients were included in the analysis, and 89 (26.1%) received UBPBs. Unacceptable fracture reduction occurred in 14.8% of cases using N 2 O, 7.9% using UBPB, and 8.5% using ketamine/propofol sedation. Relative to N 2 O, UBPB and ketamine/propofol were associated with adjusted odds ratios of 0.3 (95% CI: 0.1-0.9) and 0.4 (95% CI: 0.1-1.6), respectively, for unacceptable reduction.

CONCLUSIONS

Our findings indicate that UBPB performed by pediatric emergency physicians is associated with a reduced risk of unacceptable reductions relative to standard methods of sedation. However, prospective studies are necessary to confirm these results.