Bloqueos nerviosos para el tratamiento inicial del dolor de la fractura femoral en niños
Appendices
Appendix 1. Search strategies
The Cochrane Library (Wiley Online Library interface)
#1 MeSH descriptor: [Femoral Fractures] this term only (176)
#2 (femur* or femoral or thigh*) near/4 fracture*:ti,ab,kw (Word variations have been searched) (972)
#3 #1 or #2 (972)
#4 [mh ^Analgesia] or [mh Analgesics] (14896)
#5 [mh ^"Anesthesia, Local"] or [mh ^"Nerve Block"] (3650)
#6 (anaesthet* or anesthet* or anaesthesia or anesthesia) near/4 (regional* or local*):ti,ab,kw (Word variations have been searched)
(9841)
#7 (nerv* or femoral or fascia iliaca) near/1 block*:ti,ab,kw (Word variations have been searched) (3053)
#8 #4 or #5 or #6 or #7 (23939)
#9MeSH descriptor: [Pediatrics] explode all trees (454)
#10 [mh ^adolescent] or [mh child] or [mh infant] (79466)
#11 neonate* or newborn or baby or babies or infant* or child* or teenage* or teen* or adolescen* or schoolchild* or school age or preschool* or toddler* or boy* or girl* or minors or pubert* or pubescen* or prepubescent* or paediatric* or pediatric or youth*:ti,ab,kw (Word variations have been searched) (143176)
#12 #9 or #10 or #11 (143202)
#13 #3 and #8 and #12 (6)
#14 #3 and #8 50 [Trials]
MEDLINE (Ovid interface)
1 Femoral Fractures/ (12067)
2 ((femur$ or femoral or thigh$) adj4 fracture$).tw. (14155)
3 1 or 2 (20192)
4 Analgesia/ or exp Analgesics/ (145060)
5 Anesthesia, Local/ or Nerve Block/ (25025)
6 ((an?esthet$ or an?esthesia) adj4 (regional$ or local$)).tw. (35874)
7 ((nerv$ or femoral or fascia iliaca) adj1 block$).tw. (6377)
8 or/4‐7 (194075)
9 exp Pediatrics/ (40523)
10 Adolescent/ or exp Child/ or exp Infant/ (2678294)
11 (neonate$ or newborn or baby or babies or infant$ or child$ or teenage$ or teen$ or adolescen$ or schoolchild$ or school age or preschool$ or toddler$ or boy$ or girl$ or minors or pubert$ or pubescen$ or prepubescent$ or p?ediatric$ or youth$).tw. (1420906)
12 or/9‐11 (2961882)
13 and/3,8,12 (39)
14 Randomized controlled trial.pt. (336447)
15 Controlled clinical trial.pt. (84865)
16 randomized.ab. (240254)
17 placebo.ab. (133946)
18 Drug therapy.fs. (1566489)
19 randomly.ab. (172619)
20 trial.ab. (247214)
21 groups.ab. (1129665)
22 or/14‐21 (2917602)
23 exp Animals/ not Humans/ (3744370)
24 22 not 23 (2478371)
25 13 and 24 (12)
EMBASE (Ovid interface)
1 Femur Fracture/ (14103)
2 ((femur$ or femoral or thigh$) adj4 fractur$).tw. (17826)
3 1 or 2 (24495)
4 Analgesia/ or exp Analgesic Agent/ (615030)
5 Local Anesthesia/ or Nerve Block/ (41457)
6 ((an?esthet$ or an?esthesia) adj4 (regional$ or local$)).tw. (47927)
7 ((nerv$ or femoral or fascia iliaca) adj1 block$).tw. (9108)
8 4 or 5 or 6 or 7 (670881)
9 exp Pediatrics/ (68317)
10 Adolescent/ or exp Child/ or exp Infant/ (2247949)
11 (neonate$ or newborn or baby or babies or infant$ or child$ or teenage$ or teen$ or adolescen$ or schoolchild$ or school age or preschool$ or toddler$ or boy$ or girl$ or minors or pubert$ or pubescen$ or prepubescent$ or p?ediatric$ or youth$).tw. (1746988)
12 9 or 10 or 11 (2885318)
13 and/3,8,12 (111)
14 Randomized Controlled Trial/ (334840)
15 Clinical Trial/ (875392)
16 Controlled Clinical Trial/ (393603)
17 Randomization/ (60305)
18 Single Blind Procedure/ (16822)
19 Double Blind Procedure/ (112519)
20 Crossover Procedure/ (35869)
21 Placebo/ (211086)
22 Prospective Study/ (222307)
23 ((clinical or controlled or comparative or placebo or prospective$ or randomi#ed) adj3 (trial or study)).tw. (664413)
24 (random$ adj7 (allocat$ or allot$ or assign$ or basis$ or divid$ or order$)).tw. (161857)
25 ((singl$ or doubl$ or trebl$ or tripl$) adj7 (blind$ or mask$)).tw. (150070)
26 (cross?over$ or (cross adj1 over$)).tw. (64138)
27 ((allocat$ or allot$ or assign$ or divid$) adj3 (condition$ or experiment$ or intervention$ or treatment$ or therap$ or control$ or group$)).tw. (204239)
28 RCT.tw. (10694)
29 or/14‐28 (1751334)
30 Case Study/ or Abstract Report/ or Letter/ (872507)
31 29 not 30 (1715084)
32 13 and 31 (8)
Google Scholar
("femoral nerve block" AND "Randomized Clinical Trial" AND child AND “femur fracture”) (94)
ClinicalTrials.gov
(femur OR femoral OR thigh OR leg) AND (child OR infant OR adolescent OR pediatric) AND (fracture OR break) AND (pain OR analgesia OR analgesic OR anesthesia OR anaesthesia OR anesthetic OR anaesthetic OR FNB OR FIB OR block) (26)
WHO ICTRP
(femur OR femoral) and clinical trials in children (24)
Study flow diagram
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.
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.
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).
| 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] | |
