Intravenous regional anesthesia in the treatment of forearm and wrist fractures and dislocations in children

Can J Surg. 1993 Jun;36(3):225-8.

Abstract

Objective: To evaluate the efficacy and safety of intravenous regional anesthesia in the treatment of unilateral closed fractures and dislocations of forearm or wrist in children.

Design: A prospective study over 6 years.

Setting: The study was undertaken in the well-equipped emergency department of a community general hospital for ambulatory patients.

Patients: One hundred and thirty-nine children between the ages of 4 and 18 years with unilateral closed fractures and dislocations of forearm or wrist.

Intervention: All children received premedication with a combination of meperidine and promethazine (0.5 mg/kg intramuscularly) and regional upper limb anesthesia with 0.5% lidocaine solution (3 mg/kg intravenously) after inflation of an arm tourniquet.

Main outcome measures: The relief of pain, allowing closed reduction with intravenous regional anesthesia, and the incidence of complications.

Results: All patients had complete relief of pain allowing successful closed reduction in 133 patients (96%); tourniquet pain occurred in 10 patients (7%). There were no symptoms of lidocaine toxicity. There were no neurovascular or compartment syndrome complications.

Conclusions: Intravenous regional anesthesia for the treatment of fractures and dislocations of forearm and wrist in children was found to be simple, safe and effective.

MeSH terms

  • Adolescent
  • Anesthesia, Conduction*
  • Anesthesia, Intravenous*
  • Child
  • Child, Preschool
  • Elbow Joint / injuries
  • Elbow Joint / surgery
  • Female
  • Forearm Injuries / surgery*
  • Fractures, Closed / diagnostic imaging
  • Fractures, Closed / surgery*
  • Humans
  • Joint Dislocations / surgery*
  • Lidocaine / administration & dosage*
  • Male
  • Prospective Studies
  • Radiography
  • Radius Fractures / surgery
  • Treatment Outcome
  • Ulna Fractures / surgery
  • Wrist Injuries / diagnostic imaging
  • Wrist Injuries / surgery*

Substances

  • Lidocaine