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Regional anaesthesia worked well for children with femoral shaft fractures

Three Part Question

In [children with femoral shaft fractures] is [femoral nerve block] effective in [reducing pain and distress and reducing the need for supplemental analgesia]?

Clinical Scenario

A 6 year old child presents to the Emergency department with an undisplaced fracture of the mid femur. You have used femoral nerve blocks in adult patients with similar fractures and wonder whether this block is useful in children.

Search Strategy

Medline 1966-03/00 using the OVID interface.
[({exp femur OR OR} AND {exp fractures OR exp fractures,closed OR exp fractures, open OR fracture$.mp}) OR exp femoral fractures OR femoral fracture$.mp] AND {exp anesthesia, local OR local anesthesi$ OR exp nerve block OR regional OR nerve OR femoral} LIMIT to human AND english.

Search Outcome

39 papers found of which 36 were irrelevant or of insufficient quality. The remaining 3 papers are shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Tondare AS and Nadkarni AV.
25 patients with fractured shaft of femur aged 5 - 35 years. Lignocaine blocks Subjective and objective measures of pain before and after the block.Observational.Need for supplemenntal analgesia5 of 25Not controlled. Pain scores not reported. No statistical analysis.
McGlone R, et al.
27 consecutive patients with femoral shaft fractures. 3 children. Lignocaine blocks.Pain assessed pre and post block.Observational.Pain scoreFalls notedNot controlled. No statistical analysis.
Ronchi L, et al.
14 children with fractures of the femoral shaft aged 2 - 10 years. Bupivicaine blocks. Pain assessed pre and post block.Observational.Need for supplemental analgesiaNone in 13 of 14 childrenNot controlled. No statistical analysis.
Pain scaleMarked falls in 13 of 14 children
Time to onset of pain8 +/- 3.5 min


None of the studies are of high quality in that none had a control group. Nevertheless the evidence suggests that femoral nerve block is effective in children.

Clinical Bottom Line

Femoral nerve block is effective in reducing the pain of femoral shaft fractures in children.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.


  1. Tondare AS and Nadkarni AV. Femoral nerve block for fractured shaft of femur. Can Anaest Soc J 1982;29(3):270-1.
  2. McGlone R, Sadhra K, Hamer DW, Pritty PE. Femoral nerve block in the initial management of femoral shaft fractures. Arch Emerg Med 1987;4(3):163-8.
  3. Ronchi L, Rosenbaum D, Athouel A, et al. Femoral nerve blockade in children using bupivacaine. Anesthesiol 1989;70(4):622-4.