The use of local anesthetic techniques for closed forearm fracture reduction in children - A survey of academic pediatric emergency departments

Background: Although local anesthetic techniques (hematoma blocks, nerve blocks, intravenous regional anesthesia) for forearm fracture reduction are well described and commonly used in adults, it is unclear how often these techniques are used in children. Objective: To characterize the use of local anesthesia for pediatric closed forearm fracture reduction by pediatric and orthopedic physicians practicing in teaching hospitals in Canada and the United States. Methods: An on-line survey targeting physicians practicing in hospitals with pediatric emergency medicine (PEM) fellowships in Canada and the United States was sent to the PEM fellowship director and orthopedic department head at each hospital. Results: Sixty-three orthopedic surgeons and 69 PEM physicians were invited to participate in the survey, and 63% responded of all invited participants. All respondents routinely use sedation for forearm fracture reduction. Local anesthesia is used by 78% of respondents (55% rarely, 28% sometimes, and 17% frequently). Hematoma blocks are used by 92% of respondents who use local anesthesia; 20% use Bier blocks, and 2% use cubital blocks. Among respondents who never use local anesthesia, all believe that sufficient analgesia is obtained from procedural sedation alone, and 35% believe that local anesthesia is ineffective. Conclusions: Local anesthetic techniques are used only occasionally by those surveyed. More studies examining the use of local anesthesia for forearm fractures in children are necessary to evaluate the need for more widespread use.