<< Pediatric Nerve Blocks: An Evidence-Based Approach (Trauma CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report. To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study will be included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.

  1. *Dillion DC, Gibbs MA. Local and regional anesthesia. In: Tintinalli JE, Stapczynski JS, Cline DM, et al, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. (Textbook)
  2. * Crystal CS, Blankenship RB. Local anesthetics and peripheral nerve blocks in the emergency department. Emerg Med Clin North Am. 2005;23(2):477-502. (Review)
  3. * Ross AK, Bryskin RB. Regional anesthesia. In: Davis PJ, Cladis FP, Motoyama EK. Smith’s Anesthesia for Infants and Children. 8th ed. Philadelphia, PA: Mosby, Inc.; 2011. (Textbook)
  4. * Trott AT. Inflitration and Nerve anesthesia. In: Wounds and Lacerations: Emergency Care and Closure. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012. (Textbook)
  5. Faccenda KA, Finucane BT. Complications of regional anesthesia: incidence and prevention. Drug Saft. 2001;24(6):413- 442. (Review)
  6. Auroy Y, Narchi P, Messiah A, et al. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87(3):479-486. (Prospective survey; 21,278 patients)
  7. Neal JM, Bernards CM, Butterworth JF 4th, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):152-161. (Practice advisory)
  8. Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83(5):904-912. (Prospective observational study)
  9. Ecoffey C, Lacroix F, Giaufré E, et al. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Ped Anesth. 2010;20(12):1061- 1069. (Prospective observational study)
  10. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstruc Surg. 2001;108(1):114-124. (Review article)
  11. Chowdhry S, Seidenstricker L, Cooney DS, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstruc Surg. 2010;126(6):2031-2034. (Retrospective review; 1111 cases)
  12. Hafner HM, Rocken M, Breuninger H. Epinephrine-supplemental local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. Journal der Duetschen Dermatologischen Gesellschaft. 2005;3:195-199. (Prospective observational study)
  13. * Suresh S, Birmingham PK, Kozlowski RJ. Pediatric pain management. Anesthesiol Clin. 2012;30(1):101-117. (Review)
  14. * Spektor M, Kelly J. Nerve blocks of the thorax and extremities. In: Roberts J, Hedges J, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:513-534. (Textbook)
  15. * Thomsen, TW, Setnik GS. Procedure Consults: Emergency Medicine. Elsevier, 2008. (Website video)
  16. Tzeng Y, Chen S. Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med. 2012;30(4):592-596. (Prospective study; 123 patients)
  17. Cannon B, Chan L, Rowlinson J, et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010;27:533-536. (Singleblind prospective multicenter randomized controlled study; 73 patients)
  18. Liebmann O, Price D, Mills C, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48:558-562. (Prospective observational study; 11 patients)
  19. Tobias JD. New insights into regional anesthesia in children: new techniques and new indications. Curr Opin Anaesthesiol. 2001;14(3):345-352. (Review article)
  20. Dalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989;69(6):705-713. (Prospective randomized study; 120 patients)
  21. Wathen JE, Gao D, Merritt G, et al. A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Ann Emerg Med. 2007;50(2):162- 171. (Randomized study; 55 patients)
  22. Redborg KE, Antonakakis JG, Beach ML, et al. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256-260.
  23. Kapral S, Krafft P, Eibenberger K, et al. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994;78(3):507-513. (Prospective randomized study; 40 patients)
  24. * Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anesthesia. Br J Anaesth. 2005; 94(1):7-17. (Review article)
  25. Marhofer P, Sitzwohl C, Greher M, et al. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004; 59(7):642-646. (Prospective randomized study; 40 patients)
  26. Gray AT, Schaffhalter-Zoppoth I. Ultrasound guidance for ulnar nerve block. Reg Anesth Pain Med. 2003;28(4):335-339. (Case report)
  27. Oberndorfer U, Marhofer P, Bosenberg A, et al. Ultrasonographic guidance for sciatic and femoral blocks in children. Br J Anaesth. 2007;98(6):797-801. (Prospective randomized study; 46 patients)
  28. Willschke H, Marhofer P, Bosenberg A, et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95(2):226-230. (Prospective randomized study; 100 patients)
  29. Willschke H, Bosenberg A, Marhofer P, et al. Ultrasonographic- guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg. 2006;102:1680-1684. (Prospective observational)
  30. Chan VWS, Perlas A, McCartney CJL, et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-182. (Prospective randomized study; 188 patients)
  31. Liu FC, Liou JT, Tsai YF, et al. Efficacy of ultrasound-guided axillary brachial plexus block: a comparative study with a nerve stimulator-guided method. Chang Gung Med J. 2005;28:396-402. (Prospective randomized study; 90 patients)
  32. * Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008;52(6):727-737. (Review article)
  33. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2006;89:254-259. (Prospective observational study)
  34. Sandhu NS, Manne JS, Medabalmi PK, et al. Sonographically guided infraclavicular brachial plexus block in adults. A retrospective analysis of 1146 cases. J Ultrasound Med. 2006;25:1555-1561. (Retrospective study)
  35. Begeleisen P, Wilson M. A comparision of two techniques for ultrasound guided infraclavicular block. Br J Anaesth. 2006;96:502- 507. (Prospective randomized study; 202 patients)
  36. Sites B, Spence BC, Gallagher JD, et al. Characterizing novice behaviours associated with learning ultrasoundguided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;32:107-115. (Prospective observational study)
  37. Kapral S. Krafft P, Gosch M, et al. Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. Reg Anesth. 1995;20:323-328. (Abstract)
  38. Orebaugh SL, Williams BA, Kentor ML. Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade. Reg Anesth Pain Med. 2007;32:448-454. (Retrospective analysis)
  39. Soeding PF, Sha S, Royse CE, et al. A randomized trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery. Anaesth Intensive Care. 2005;33(6):719-725. (Prospective randomized study; 40 patients)
  40. * Walker KJ, McGrattan K, Aas-Eng K, et al. Ultrasound guidance for peripheral nerve blockade. Cochrane Database Syst Rev. 2009;(4):CD006459. (Cochrane review)
  41.  Langford RA, Hockey B, Leslie K. Monitor position and the accuracy and speed of ultrasound-guided nerve blocks. Anaesthesia. 2009;64(8):845-849. (Prospective randomized study; 31 patients)

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