{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T11:02:36Z","timestamp":1794654156497,"version":"4.9.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"Jane & Dan Olsson Foundation"},{"name":"H.K.H. Kronprinsessan Lovisa Foundation for Pediatric Care & Axel Tielman Memorial Foundation"},{"name":"Foundation Konung Oscar II:s och Drottning Sofias Guldbr\u00f6llopsminne"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>Ultrasound-guided nerve blocks are commonly used in pediatric anesthesia and have excellent safety profiles. This study aims to compare outcomes of forearm fracture reductions that were performed using regional anesthesia with ultrasound-guided brachial plexus nerve blocks (UBPB) versus those performed using nitrous oxide (N<jats:sub>2<\/jats:sub>O) sedation with hematoma block or sedation with ketamine or propofol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This single-center retrospective cohort study included patients under 15 years of age who underwent closed forearm fracture reduction in a tertiary care pediatric emergency department from 2019 to 2024. Data were extracted from electronic health records and analyzed for demographic, clinical, and radiographic variables. The primary outcome was the association between sedation method and the likelihood of an unacceptable fracture reduction, adjusted for confounder variables.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Three hundred forty-one patients were included in the analysis, and 89 (26.1%) received UBPBs. Unacceptable fracture reduction occurred in 14.8% of cases using N<jats:sub>2<\/jats:sub>O, 7.9% using UBPB, and 8.5% using ketamine\/propofol sedation. Relative to N<jats:sub>2<\/jats:sub>O, UBPB and ketamine\/propofol were associated with adjusted odds ratios of 0.3 (95% CI: 0.1-0.9) and 0.4 (95% CI: 0.1-1.6), respectively, for unacceptable reduction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our findings indicate that UBPB performed by pediatric emergency physicians is associated with a reduced risk of unacceptable reductions relative to standard methods of sedation. However, prospective studies are necessary to confirm these results.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003444","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T10:00:12Z","timestamp":1752573612000},"page":"e150-e155","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of Ultrasound-Guided Brachial Plexus Blocks Performed by Pediatric Emergency Physicians for the Reduction of Forearm Fractures"],"prefix":"10.1097","volume":"41","author":[{"given":"Albano","family":"de Juan Plaza","sequence":"first","affiliation":[{"name":"Department of Pediatric Emergency Care, Astrid Lindgren Children\u2019s Hospital, Karolinska University Hospital"},{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol","family":"Gawelovicz","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet"},{"name":"Department of Pediatric Orthopedics, Astrid Lindgren Children\u2019s Hospital, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Edner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Care, Astrid Lindgren Children\u2019s Hospital, Karolinska University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Katzir","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Care, Hillel Yaffe Medical Center of Israel, Hadera, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Granath","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"von Heideken","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet"},{"name":"Department of Pediatric Orthopedics, Astrid Lindgren Children\u2019s Hospital, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0275-0402","authenticated-orcid":false,"given":"Aron","family":"Kerenyi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Care, Astrid Lindgren Children\u2019s Hospital, Karolinska University Hospital"},{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"R1-20251001","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/BPO.0000000000000595","article-title":"Epidemiology of pediatric fractures presenting to emergency departments in the United States","volume":"36","author":"Naranje","year":"2016","journal-title":"J Pediatr Orthop"},{"key":"R2-20251001","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1007\/s00431-021-03930-6","article-title":"Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice","volume":"180","author":"Sahyoun","year":"2021","journal-title":"Eur J Pediatr"},{"key":"R3-20251001","doi-asserted-by":"crossref","first-page":"e011384","DOI":"10.1136\/bmjopen-2016-011384","article-title":"Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review 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children","volume":"40","author":"Katzir","year":"2024","journal-title":"Pediatr Emerg Care"},{"key":"R11-20251001","doi-asserted-by":"crossref","first-page":"e12886","DOI":"10.1002\/emp2.12886","article-title":"Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: a systematic review and meta-analysis","volume":"4","author":"Kuypers","year":"2023","journal-title":"J Am Coll Emerg Physicians Open"},{"key":"R12-20251001","doi-asserted-by":"crossref","first-page":"e324","DOI":"10.1097\/PEC.0000000000002190","article-title":"Sedoanalgesia versus infraclavicular block for closed reduction of pediatric forearm fracture in emergency department: prospective randomized study","volume":"37","author":"Karagoz","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"R13-20251001","doi-asserted-by":"crossref","first-page":"e1684","DOI":"10.1097\/PEC.0000000000002878","article-title":"Ultrasound-guided supraclavicular brachial plexus blocks performed by pediatric emergency medicine physicians for painful orthopedic procedures in a pediatric emergency department\u2014a case series","volume":"38","author":"Shahar-Nissan","year":"2022","journal-title":"Pediatr Emerg Care"},{"key":"R14-20251001","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/PEC.0000000000002805","article-title":"Risk factors for failure of closed forearm fracture reduction in the pediatric emergency department","volume":"39","author":"Cohen","year":"2023","journal-title":"Pediatr Emerg Care"},{"key":"R15-20251001","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1136\/emermed-2023-213591","article-title":"Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study","volume":"41","author":"Pitman","year":"2024","journal-title":"Emerg Med J"},{"key":"R16-20251001","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1136\/emermed-2021-212108","article-title":"Comparative efficacy of anaesthetic methods for closed reduction of paediatric forearm fractures: a systematic review","volume":"39","author":"Goh","year":"2022","journal-title":"Emerg Med J"}],"updated-by":[{"DOI":"10.1097\/pec.0000000000003511","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000}}],"container-title":["Pediatric Emergency 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