The use of landmark-guided femoral nerve blocks for acute pain relief in pediatric patients with femur fractures was first described in 1979 (1). Regional blocks are used widely by anesthetists to manage intra and post-operative pain. However there has been variable uptake into other pediatric specialties, including pediatric emergency medicine.

 

Why Ultrasound?

Traditionally, femoral nerve blocks were performed using anatomic landmarks. However, in the late 1980’s ultrasound began to be used for procedural guidance and by the 2000’s, it’s use was commonplace (2, 3). Today, ultrasound-guidance for femoral nerve blocks is routine and provides several benefits over the traditional approach (table 1). In fact, many now consider it to be standard of care.

 

Table 1: Advantages of ultrasound-guided nerve blocks (4)

 

A retrospective pre- vs. post-implementation cohort study evaluating emergency physician performed femoral nerve blocks for pediatric patients presenting with acute femur fractures found that patients who received ultrasound-guided femoral nerve blocks for femur fracture pain, had longer duration of analgesia, required fewer doses of analgesic medications, and needed fewer nursing interventions than those patients receiving enteral or parenteral analgesic alone (5). When done appropriately, ultrasound-guided femoral nerve blocks are safe, effective and provide optimal pain relief for acute injuries.