Exploring the Feasibility of Ultrasound-Guided Supraclavicular Nerve Blocks for Distal Forearm Fracture Management in Pediatric Patients

Background: Forearm fractures are common presentations to the emergency department (ED), frequently requiring reduction and immobilization. In the pediatric population, procedural sedation is the gold standard to allow for appropriate analgesia, patient compliance, and ultimate successful reduction. Hematoma block is another means of analgesia prior to reduction. Hematoma block, however, is often associated with less pain control, limiting quality of reduction. Procedural sedation increases length of stay, resource allocation, and can be associated with complications. A possible alternative for analgesia to facilitate reduction of forearm fractures in the ED, are ultrasound-guided nerve blocks. This is especially significant for the pediatric population, as non-surgical treatment is frequently the standard of care. Methods: Illustrative case series of three pediatric patients who underwent supraclavicular nerve block for management of distal forearm fracture at a tertiary hospital. Results: The indication for supraclavicular nerve block was unique in all patients; avoiding procedural sedation to monitor Glasgow Coma Scale, avoidance of numerous doses of opioids for analgesia, and parental preference to avoid risks of complications associated with procedural sedation. Each reduction was successful on the first attempt. There was no surgical intervention or adverse events in our patients. Conclusions: Supraclavicular nerve block provided a successful alternative to procedural sedation for reduction, analgesia, without adverse events. It holds exceptional potential as an alternative to procedural sedation in a variety of clinical scenarios.