1
|
Heffler MA, Brant JA, Singh A, Toney AG, Harel-Sterling M, Grandjean-Blanchet C, Riera A, Khalil PA, Starr-Seal RL, Binder ZW. Ultrasound-Guided Regional Anesthesia of the Femoral Nerve in the Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:e30-e34. [PMID: 35245015 DOI: 10.1097/pec.0000000000002607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Femur fractures are painful, and use of systemic opioids and other sedatives can be dangerous in pediatric patients. The fascia iliaca compartment nerve block and femoral nerve block are regional anesthesia techniques to provide analgesia by anesthetizing the femoral nerve. They are widely used in adult patients and are associated with good effect and reduced opioid use. Ultrasound (US) guidance of nerve blocks can increase their safety and efficacy. We sought to report on the use and safety of US-guided regional anesthesia of the femoral nerve performed by emergency physicians for femur fractures in 6 pediatric emergency departments. METHODS Records were queried at 6 pediatric EDs across North America to identify patients with femur fractures managed with US-guided regional anesthesia of the femoral nerve between January 1, 2016, and May 1, 2021. Data were abstracted regarding demographics, injury pattern, nerve block technique, and analgesic use before and after nerve block. RESULTS Eighty-five cases were identified. Median age was 5 years (interquartile range, 2-9 years). Most patients were male and had sustained blunt trauma (59% low-mechanism falls). Ninety-four percent of injuries were managed operatively. Most patients (79%) received intravenous opioid analgesia before their nerve block. Ropivacaine was the most common local anesthetic used (69% of blocks). No procedural complications or adverse effects were identified. CONCLUSIONS Ultrasound-guided regional anesthesia of the femoral nerve is widely performed and can be performed safely on pediatric patients by emergency physicians and trainees in the pediatric emergency department.
Collapse
Affiliation(s)
- Michael A Heffler
- From the Denver Health Residency in Emergency Medicine, Denver Health Medical Center, Denver
| | - Julia A Brant
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Amar Singh
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Amanda G Toney
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, Aurora, CO
| | - Maya Harel-Sterling
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Grandjean-Blanchet
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Riera
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University, New Haven, CT
| | - Paul A Khalil
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Rebecca L Starr-Seal
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Zachary W Binder
- Division of Emergency Medicine, Department of Pediatrics, University of Massachusetts Memorial Medical Center, University of Massachusetts, Worchester, MA
| |
Collapse
|
2
|
Prehospital Ultrasound-Guided Pediatric Fascia Iliaca Block. Air Med J 2023; 42:61-63. [PMID: 36710039 DOI: 10.1016/j.amj.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
The fascia iliaca block (FIB) provides effective regional anesthesia for fractures of the femur. There is 1 previous case report of a prehospital FIB in a child using a landmark technique. We report the successful prehospital application of a FIB using ultrasound guidance in a 7-year-old girl.
Collapse
|
3
|
Cai Q, Han Y, Gao M, Ni S. Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6324009. [PMID: 35463653 PMCID: PMC9023192 DOI: 10.1155/2022/6324009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
In the process of surgical treatment, the introduction of ultrasound technology to implement nerve block anesthesia can make the operations of patients with fractures under visualization and it can also significantly improve the anesthesia effect. With this technology, it is possible to minimize the anesthesia operation causing accidental injury and lay a good foundation for the smooth operation of surgical treatment. Blockchain technology is a new decentralized infrastructure and distributed computing paradigm. This technology has great development opportunities in the medical field and is expected to play an important role in the construction of Internet medical ecology. This study aims to investigate the effect of ultrasound-guided nerve block anesthesia on fracture treatment in the context of blockchain. This method has high application value and potential in medical data sharing, reducing treatment costs, improving the medical claims system, strengthening medical management, and optimizing medical decision-making using blockchain technology. This study also addresses the uniqueness and complexity of ultrasound-guided nerve block anesthesia itself and analyzes the effect of the proposed method. The analysis shows that using the internet-based blockchain ultrasound-guided subacromial nerve block anesthesia for fracture patients is effective, and the patient's vital signs are stable, and the block is effective.
Collapse
Affiliation(s)
- Qiang Cai
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei, China
| | - Yi Han
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meiling Gao
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Shuqin Ni
- Department of Anesthesiology, Yantaishan Hospital, Yantai 264003, Shandong, China
| |
Collapse
|
4
|
Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
Collapse
Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| |
Collapse
|
5
|
Kaye AD, Green JB, Davidson KS, Gennuso SA, Brown ML, Pinner AM, Renschler JS, Cramer KD, Kaye RJ, Cornett EM, Helmstetter JA, Urman RD, Fox CJ. Newer nerve blocks in pediatric surgery. Best Pract Res Clin Anaesthesiol 2019; 33:447-463. [PMID: 31791563 DOI: 10.1016/j.bpa.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE OF THE REVIEW The purpose of this manuscript is to provide a brief discussion of the current direction in pediatric regional anesthesia, highlighting both newer nerve blocks and techniques and traditional nerve blocks. RECENT FINDINGS The number of nerve blocks performed in pediatric patients continues to increase. This growth is likely related in part to the recent focus on perioperative multimodal analgesia, in addition to growing data demonstrating safety and efficacy in this patient population. Multiple studies by the Pediatric Regional Anesthesia Network (PRAN) and the French-Language Society of Pediatric Anesthesiologists (ADARPEF) have demonstrated lack of major complications and general overall safety with pediatric nerve blocks. The growing prevalence of ultrasound-guided regional anesthesia has not only improved the safety profile, but also increased the efficacy of both peripheral nerve blocks and perineural catheters. SUMMARY As the push for multimodal analgesia increases and the breadth of pediatric regional anesthesia continues to expand, further large prospective studies will be needed to demonstrate continued efficacy and overall safety.
Collapse
Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA 70112, United States.
| | - Jeremy B Green
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Ave., Suite 659, New Orleans, LA, 70112, United States.
| | - Kelly S Davidson
- Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Avenue, Suite 659, New Orleans, LA 70112, United States.
| | - Sonja A Gennuso
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | - Morgan L Brown
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Allison M Pinner
- Ochsner LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | - Jordan S Renschler
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Kelsey D Cramer
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States.
| | - Charles J Fox
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States
| |
Collapse
|
6
|
Gonzalez LK, Yellin S, Arroyo AC. Point-of-Care Ultrasound in the Pediatric Emergency Department: Where We're at, Where We're Going. Adv Pediatr 2018; 65:121-142. [PMID: 30053920 DOI: 10.1016/j.yapd.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura K Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA
| | - Sharon Yellin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA
| | - Alexander C Arroyo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA.
| |
Collapse
|
7
|
Wilson C. Feeling Blocked? Another Pain Management Tool in the Emergency Department. Ann Emerg Med 2018; 72:120-126. [PMID: 29729812 DOI: 10.1016/j.annemergmed.2018.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Casey Wilson
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD.
| |
Collapse
|
8
|
Mori T, Hagiwara Y. Ultrasound-Guided Popliteal Sciatic Nerve Block for an Ankle Laceration in a Pediatric Emergency Department. Pediatr Emerg Care 2017; 33:803-805. [PMID: 29095385 DOI: 10.1097/pec.0000000000001334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although ultrasound-guided peripheral nerve block has recently been introduced into pediatric emergency departments, knowledge of its use is limited. We present here a case demonstrating the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block for a pediatric spoke injury in a pediatric emergency department setting.
Collapse
Affiliation(s)
- Takaaki Mori
- From the Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Japan
| | | |
Collapse
|
9
|
Zhang B, Li Q, Shi C, Zhang X. Drug-Induced Pseudoallergy: A Review of the Causes and Mechanisms. Pharmacology 2017; 101:104-110. [PMID: 29136631 DOI: 10.1159/000479878] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
Abstract
Adverse drug reactions occur frequently and can trigger pseudoallergy, which has become a serious threat to public health. Pseudoallergy is a typical non-immune anaphylactic reaction characterized by the independence of antigen-specific immune responses. In the clinic, pseudoallergy is often elicited by the first dose of medication, and here lies its unpredictability and occasional lethal outcome. However, the mechanisms of pseudoallergy are not well understood. This review focusses on the causes and mechanisms of pseudoallergy induced by drugs. Two categories of mechanisms will be considered, namely, (1) complement activation-related pseudoallergy and (2) mast cell activation-related pseudoallergy. The factors that induce pseudoallergy include opioid drugs, complement activation-related pseudoallergenic drugs, nonsteroidal anti-inflammatory drugs and traditional Chinese medicine injections.
Collapse
Affiliation(s)
- Bo Zhang
- Department of Pharmacology, Institute of Materia Medica, Zhejiang Academy of Medical Sciences, Hangzhou, PR China
| | | | | | | |
Collapse
|
10
|
Elsey NM, Tobias JD, Klingele KE, Beltran RJ, Bhalla T, Martin D, Veneziano G, Rice J, Tumin D. A prospective, double-blinded, randomized comparison of ultrasound-guided femoral nerve block with lateral femoral cutaneous nerve block versus standard anesthetic management for pain control during and after traumatic femur fracture repair in the pediatric population. J Pain Res 2017; 10:2177-2182. [PMID: 28919813 PMCID: PMC5590772 DOI: 10.2147/jpr.s139106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Traumatic injury of the femur resulting in femoral fracture may result in significant postoperative pain. As with other causes of acute pain, regional anesthesia may offer a benefit over conventional therapy with intravenous opioids. This study prospectively assesses the effects of femoral nerve blockade with a lateral femoral cutaneous nerve block (FN-LFCN) on intraoperative anesthetic requirements, postoperative pain scores, and opioid requirements. Materials and methods Seventeen pediatric patients (age 2–18 years) undergoing surgical repair of a traumatic femur fracture fulfilled the study criteria and were randomly assigned to general anesthesia with either an FN-LFCN block (n = 10) or intravenous opioids (n = 7). All patients received a general anesthetic with isoflurane for maintenance anesthesia during the surgical repair of the femur fracture. Patients randomized to the FN-LFCN block group received ultrasound-guided nerve blockade using ropivacaine (0.2%/0.5% based on patient weight). At the conclusion of surgery, the airway device was removed once tracheal extubation criteria were achieved, and patients were transported to the post-anesthesia care unit (PACU) for recovery and assessment of pain by a blinded study nurse. Results The final study cohort included 17 patients (n = 10 for FN-LFCN block group; n = 7 for the intravenous opioid group). Although the median of the maximum postoperative pain scores in the regional group was 0, this did not reach statistical significance when compared to the median pain score of 3 in the intravenous opioid group. Likewise, no difference between the two groups was noted when comparing intraoperative anesthetic requirements, opioid requirements (intraoperative, in the post-anesthesia recovery room, and in the inpatient ward), and the time to first opioid requirement postoperatively in the inpatient ward. Conclusion This prospective, randomized, double-blinded study failed to demonstrate a clear benefit of regional anesthesia over intravenous opioids intraoperatively and postoperatively during repair of femoral shaft fractures in the pediatric population.
Collapse
Affiliation(s)
- Nicole M Elsey
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University.,Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine
| | - Kevin E Klingele
- Department of Orthopedic Surgery and Sports Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Ralph J Beltran
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| | - David Martin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| | - Giorgio Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| | - Julie Rice
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.,The Ohio State University
| |
Collapse
|
11
|
Snelling PJ, Tessaro M. Paediatric emergency medicine point-of-care ultrasound: Fundamental or fad? Emerg Med Australas 2017; 29:486-489. [PMID: 28845599 DOI: 10.1111/1742-6723.12848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Snelling
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Tessaro
- Emergency Department, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
|
13
|
Eksert S, Akay S, Kaya M, Kantemir A, Keklikci K. Ultrasound-Guided Femoral Nerve Blockage in A Patellar Dislocation: An Effective Technique for Emergency Physicians. J Emerg Med 2017; 52:699-701. [PMID: 28228343 DOI: 10.1016/j.jemermed.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/25/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED). CASE REPORT A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. The initial physical examination and plain radiography showed a patellar dislocation in the right knee. We performed an ultrasound-guided femoral nerve blockage to provide a pain-free and comfortable patellar reduction. To our best knowledge, there is no manuscript except an old case series about use of the ultrasound-guided femoral nerve blockage in the management of patellar reduction in the medical literature. Procedural sedation is the preferred method used for this purpose in ED, but these medications need to be closely monitored because of their potential complications, such as nausea, vomiting, allergic reactions, and respiratory depression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound-guided femoral nerve blockage gave rapid and effective pain control without any complication during the reduction in this patient. Therefore, we suggest this technique be used for pain management during the reduction of a dislocated patella in the ED.
Collapse
Affiliation(s)
- Sami Eksert
- Department of Anesthesia, Sirnak Military Hospital, Sirnak, Turkey
| | - Sinan Akay
- Department of Radiology, Adana Military Hospital, Adana, Turkey
| | - Murtaza Kaya
- Department of Emergency Medicine, Sirnak Military Hospital, Sirnak, Turkey
| | - Ali Kantemir
- Department of Orthopedics and Traumatology, Sirnak Military Hospital, Sirnak, Turkey
| | - Kenan Keklikci
- Department of Orthopedics and Traumatology, Sirnak Military Hospital, Sirnak, Turkey
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic. RECENT FINDINGS Recent literature has focused on updating recommendations for the use of various analgesics in the pediatric population. While codeine is no longer recommended due to increasing evidence of adverse effects, the more liberal use of intranasal fentanyl is now encouraged because of the ease of administration and rapid delivery. The evidence base for the use of ultrasound-guided regional nerve blocks by qualified providers in the acute pediatric pain setting continues to grow. SUMMARY The pediatric emergency medicine provider should be able to assess pain and develop individualized pain plans by utilizing a range of nonpharmacologic and pharmacologic strategies. Knowledge of the most recent literature and changes in recommendations for various pain medications is essential.
Collapse
|