Brachial plexus block [axillary block] for emergency orthopedic pediatric surgery versus deep sedation

ABSTRACT

Our study was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary [brachial plexus] block regional anesthesia [ABRA] [32 children] or deep sedation with ketamine and midazolam [30 children]. This was a prospective randomized unmasked controlled comparative trial conducted in hospital emergency department. The 2 groups were similar in age [older than 4 years], fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. The primary outcome measure was procedural distress during manipulation as measured with the Children's Hospital of Eastern Ontario Pain Scale [CHEOPS]. The mean CHEOPS score was 6.4 +/- 2.8 in the group with axillary block and 7.5 +/- 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant [P = 0.126, 95% CI 2.5, 0.3]. Axillary block was used successfully in 26[90%] of the 32 children. No patient in either group experienced any adverse events