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Cochrane Database of Systematic Reviews

Nerve blocks for initial pain management of femoral fractures in children

Information

DOI:
https://doi.org/10.1002/14651858.CD009587.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 17 December 2013see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Bone, Joint and Muscle Trauma Group

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Karen JL Black

    Correspondence to: Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada

    [email protected]

    [email protected]

  • Catherine A Bevan

    Childrens' Emergency Department, Royal Alexandra Children's Hospital, Brighton, UK

  • Nancy G Murphy

    IWK Emergency Department, IWK Regional Poison Centre, Halifax, Canada

  • Jason J Howard

    Department of Surgery, IWK Health Centre, Halifax, Canada

Contributions of authors

Karen Black conceived the review. Karen Black and Jason Howard designed the protocol with input at various stages from the other three authors. Karen Black and Nancy Murphy reviewed titles, abstracts and full text articles for inclusion in the review. Karen Black and Jason Howard extracted data from each study and discussed the analysis and conclusions. Karen Black and Catherine Bevan performed the risk of bias assessments and graded the quality of the studies.

Karen Black secured funding for the review and is the guarantor. Funding was provided by the Nova Scotia Health Research Foundation (NSHRF) through a Knowledge Synthesis grant. The NSHRF had no input or vested interested in any part of this review.

Sources of support

Internal sources

  • IWK Health Centre Library, Librarian Darlene Chapman, Canada.

    Search strategy support

External sources

  • Nova Scotia Health Research Foundation, Canada.

    Research Grant: the NSHRF has no vested interest in the outcome of this review.

Declarations of interest

Karen JL Black: a research grant was awarded by the Nova Scotia Health Research Foundation to support a Knowledge Synthesis project in the form of a Cochrane Systematic Review. The granting agency had no involvement in the development of the protocol. The grant did not support the researchers' salaries.
Catherine A Bevan: none known
Nancy G Murphy: none known
Jason J Howard: none known

Acknowledgements

We thank Darlene Chapman and Joanne Elliott for their assistance in designing the search strategies and for performing the searches. We thank Jill Hayden, Janet Curran and Amy Plint for their advice at all stages of protocol development and review.

Lindsey Elstub, Joanne Elliott, Vrisha Madhuri and Helen Handoll all provided constructive guidance and editing at the protocol stage for which we are grateful. Thanks, too, to Tracy Daley for her help as research assistant in this review.

We thank Xavier Griffin and Martyn Parker for their thoughtful suggestions for this review and Laura MacDonald for editorial processing. Helen Handoll provided feedback and final editing for which we thank her.

Version history

Published

Title

Stage

Authors

Version

2013 Dec 17

Nerve blocks for initial pain management of femoral fractures in children

Review

Karen JL Black, Catherine A Bevan, Nancy G Murphy, Jason J Howard

https://doi.org/10.1002/14651858.CD009587.pub2

2012 Jan 18

Nerve blocks for initial pain management of femoral fractures in children

Protocol

Karen JL Black, Nancy G Murphy, Kara Thompson, Catherine A Bevan, Jason J Howard

https://doi.org/10.1002/14651858.CD009587

Differences between protocol and review

Specific cut‐off values for pain scores were specified after the protocol but prior to analysing the results of the included study.

We used methods provided in Hozo 2005 to calculate the mean and standard deviations from median and 95% confidence interval data for an exploratory analysis of duration of analgesia.

The protocol planned for meta‐analysis of studies and related statistical analyses. The inclusion of only one study precluded these.

Keywords

MeSH

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 1 Failure of analgesia at 30 minutes.
Figures and Tables -
Analysis 1.1

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 1 Failure of analgesia at 30 minutes.

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 2 Adverse events up to 12 hours.
Figures and Tables -
Analysis 1.2

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 2 Adverse events up to 12 hours.

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 3 Pain score at 5 minutes.
Figures and Tables -
Analysis 1.3

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 3 Pain score at 5 minutes.

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 4 Duration of analgesia (minutes).
Figures and Tables -
Analysis 1.4

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 4 Duration of analgesia (minutes).

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 5 Child and parental satisfaction with provided analgesia (highly satisfied).
Figures and Tables -
Analysis 1.5

Comparison 1 Fascia iliaca compartment block versus intravenous morphine, Outcome 5 Child and parental satisfaction with provided analgesia (highly satisfied).

Comparison 1. Fascia iliaca compartment block versus intravenous morphine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Failure of analgesia at 30 minutes Show forest plot

1

54

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.09, 1.20]

1.1 Children aged up to 5 years

1

23

Risk Ratio (M‐H, Fixed, 95% CI)

0.18 [0.01, 3.47]

1.2 Children aged over 5 years

1

31

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.10, 1.70]

2 Adverse events up to 12 hours Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Respiratory depression

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 CNS (obtundation)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Vomiting

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.4 Other (pain or redness at nerve block site)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Pain score at 5 minutes Show forest plot

1

54

Mean Difference (IV, Fixed, 95% CI)

‐1.43 [‐3.06, 0.19]

3.1 FLACC (aged up to 5 years)

1

23

Mean Difference (IV, Fixed, 95% CI)

‐1.67 [‐3.88, 0.54]

3.2 FACES (aged over 5 years)

1

31

Mean Difference (IV, Fixed, 95% CI)

‐1.16 [‐3.55, 1.23]

4 Duration of analgesia (minutes) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Child and parental satisfaction with provided analgesia (highly satisfied) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 Patient satisfaction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 Parental satisfaction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Fascia iliaca compartment block versus intravenous morphine