A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department

234 for 3 days with acetaminophen appears safe in newly abstinent alcoholic patients, such as those presenting for acute medical care. ©2007 Kuffner et al.; licensee BioMed Central Ltd. doi:10.1016/j.acpain.2007.10.013 ACUTE PAIN IN EMERGENCY DEPARTMENTS A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department Ann Emerg Med 2007;50(2):162—171.e1 [date of publication: August 2007] J.E. Wathen, D. Gao, G. Merritt, G. Georgopoulos, F.K. Battan Study objective: We determine whether a fascia iliaca compartment nerve block can provide superior pain management compared with intravenous morphine sulfate for the initial pain management of femur fracture patients presenting to a pediatric emergency department. The primary outcome measured is pain scores; a difference of 15% in scores assessed at 30 min from the study’s baseline pain management is considered clinically meaningful. Secondary outcomes include the duration of analgesia, the need for additional medications, adverse events, nerve block complications, and satisfaction scores. Methods: This was a prospective, randomized, unblinded, controlled trial conducted on children aged 15 months to 18 years with acute femur fractures, presenting to a free-standing, tertiary care children’s hospital. Patients were randomized to receive intravenous morphine sulfate or a fascia iliaca compartment nerve block using ropivacaine (Naropin). Pain scores (Children’s Hospital of Eastern Ontario Pain Scale [CHEOPS]; Face, Legs, Activity, Cry and Consolability Pain Scale; Faces Pain Scale) were recorded at initial analgesic administration (baseline), at 5, 10, 15, 30, and 60 min, and then hourly up to 6 h from baseline by trained nursing observers and research assistants. Results: Fifty-five patients, 26 in the fascia iliaca compartment nerve block group and 29 in the morphine sulfate group, ranged in age from 16 months to 15 years (median 5.7 years). Baseline mean CHEOPS scores were similar: 9.4 fascia iliaca compartment nerve block and 9.5 morphine sulfate. Mean CHEOPS scores at 30 min after initial treatment were 5.87 for fascia iliaca compartment nerve block and 7.54 for morphine sulfate, with a difference of 1.67, which corresponds to an 18% (95% confidence interval [CI] 8—27%) dif-

Abstracts ference in pain reduction between the 2 groups, according to the average baseline score of 9.45. Similar lower pain scores were observed in the fascia iliaca compartment nerve block group as early as 10 min from baseline and throughout the 6-h duration of the study. In comparing the entire 6-h CHEOPS pain scores, patients who received a fascia iliaca compartment nerve block showed lower scores by approximately 15% (95% CI 6—24%) compared to patients who received morphine sulfate. Median duration of analgesia was longer in the fascia iliaca compartment nerve block group compared with that in the morphine sulfate group (313 min [95% CI 154—360 min] versus 60 min [95% CI 10—255 min]). Fewer additional medications were given to patients who received the fascia iliaca compartment nerve block. No complications from the nerve block occurred. Satisfaction scores were higher with the fascia iliaca compartment nerve block among the medical staff. Conclusion: Fascia iliaca compartment nerve block provided clinically superior pain management compared with intravenous morphine sulfate at 30 min from baseline and throughout the initial 6 h of medical treatment of children 16 months to 15 years who had isolated acute femur fractures. The results of this study, however, may be inflated by the nonblinding of the pain observers. Despite this potential bias, the fascia iliaca compartment nerve block should be considered as a valuable procedure in managing the pain commonly observed in these injured children. ©2007 American College of Emergency Physicians. doi:10.1016/j.acpain.2007.10.014 Factors influencing pain management by nurses in emergency departments in Central Africa Emerg Med J 2007;24(7):475—6 [date of publication: July 2007] R.M. Rampanjato, M. Florence, N.C. Patrick, B.T. Finucane Objective: To observe pain management practices by nurses in emergency departments (EDs) in Central Africa and to study the various factors influencing these practices. Methods: Time to first analgesic treatment was recorded in 53 patients presenting to the ED of a Central African hospital in February 2005. A survey was simultaneously conducted on the attitudes and commitment of nurses towards the management of pain. All 28 nurses assigned to the ED agreed to participate in the survey. Results: Severity of pain was the factor most influencing the time to first analgesia following