Intravenous regional anaesthesia in the treatment of paediatric forearm fractures in the emergency department

Abstract

Objective: To describe our experience using local anaesthetic‐assisted manipulation and plaster with prilocaine as a method of facilitating fracture reduction in paediatric patients; in particular, issues of efficacy and safety. Methods: Retrospective explicit chart review was performed on all paediatric patients presenting with distal forearm fractures for a 6 month period between 1 January and 31 July 1996. Data collected included: (i) the success of the procedure (defined by clinical and radiological parameters); (ii) age and gender of the patient; (iii) use of adjuvant medications; and (iv) occurrence of complications. Results: In the study period, 156 paediatric patients presented with distal forearm fractures. Of these, 78 patients required manipulation. Fifty‐three patients were treated with a local anaesthetic‐assisted manipulation and plaster, while 25 patients were admitted for a reduction under general anaesthesia. Successful fracture reduction using local anaesthetic‐assisted manipulation and plaster was achieved in 96.3% of the cases in which this method was used. With respect to safety, no adverse respiratory/haemodynamic sequelae or problems with prilocaine toxicity were found. Adjuvant medication was used frequently (49%); however, the reasons for use could not be determined in this study. Conclusions: This study suggests that local anaesthetic‐assisted manipulation and plaster using prilocaine has a high success rate and a good safety record. This should be confirmed by study of a larger population. Factors to be taken into account when considering the use of this procedure are: (i) patient and parental preference; (ii) age of the patient; (iii) experience of the available staff; (iv) availability of personnel resources; (v) impact on patient flow in the emergency department; and (vi) anticipated delay in therapy if admission for treatment under general anaesthesia is chosen.