Ultrasound-Guided Femoral Nerve Blocks in the Initial Emergency Department Management of Pediatric Femur Fractures

Femur fractures are extremely painful injuries that frequently involve a number of transfers from the field to stretcher to imaging table to hospital bed. Prompt pain relief is essential. Traditionally, systemic analgesia has been provided orally or parenterally. Systemic medicines are frequently limited by potential deleterious effects on the patient's sensorium and hemodynamic status. Alternatively, regional anesthesia targeting the femoral nerve can control femur fracture pain. A femoral nerve block, historically placed using landmark or nerve stimulator techniques, is now easier, more effective, and better tolerated by emergency department patients with the use of ultrasound guidance. This review summarizes the current state of medical evidence regarding the use of bedside ultrasound guidance to perform femoral nerve blocks for the initial management of femur fracture pain in children as well as a review of the technique.