Bier Block Regional Anesthesia versus Conscious Sedation in Pediatric Forearm Fracture Management: Clinical Outcomes and Costs

Background: Bier block, or intravenous regional block (IVRB), and Conscious Sedation (CS) can be used for pediatric forearm fracture reductions.This study compares the two.Questions/Purposes: Of the two options (IVRB vs CS) of anesthesia for pediatric fracture reduction, is one safer and more cost efficient?Patients and Methods: Arkansas Children's Hospital charts were reviewed for pediatric forearm fractures treated in the ED between 2005 and 2014.Patient age, sex, fracture type, mechanism of injury, need for further reduction, initial complications, long-term complications, number of follow-up visits, need for further operative reduction, and total weeks of care were gathered.Patient from ages 4-7 were included in the study due to the tendency of using CS for younger patients.ED room costs were compared between 18 IVRB patients and 19 CS patients.Results: Total length of care for IVRB was 5.9 weeks versus 5.6 for CS with 2.8 follow-up appointments for IVRB versus 2.7 for CS.IVRB cost $423 less than CS.There were no complications in either group. Conclusion-IVRB:Is safe and cost effective method for pediatric forearm fracture reduction compared to CS.Clinical Relevance: Eliminating the need for sedation and stream-lining fracture treatment in the pediatric ED is both safe and efficient when using IVRB.Patients are not required to be NPO and do not require prolonged recovery in the ED.