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The Journal of Bone and Joint Surgery, Vol 77, Issue 3 335-339, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Self-administered nitrous oxide and a hematoma block for analgesia in the outpatient reduction of fractures in children
WL Hennrikus, AY Shin and CE Klingelberger
Department of Orthopaedic Surgery, Naval Medical Center, San Diego 92134-5000.
We prospectively studied the efficacy and safety of self-administered
nitrous oxide combined with a hematoma block in 100 children who had a
closed reduction of a fracture in the emergency department. No child was
excluded from the study because of the type of fracture. The average
Children's Hospital of Eastern Ontario pain score (CHEOPS), as determined
by the emergency-medicine physician who observed the reduction, was 6.8
points (range, 4 to 12 points). The average grade for pain, as recalled by
the patient and indicated on a visual-analogue pain scale that ranged from
0 to 10 points, was 6.5 points before the patient received any analgesia
and 1.2 points immediately after reduction of the fracture and application
of a cast. Ninety-seven patients obtained an analgesic effect from the
combination of nitrous oxide and a hematoma block. The three remaining
children obtained no effect, and the fracture was reduced with use of
general anesthesia. Three additional reductions were technically
unsuccessful because of rotational or angular malalignment, and a second
reduction was performed with general anesthesia. There were no
complications such as vomiting, respiratory depression, a change in the
oxygen-saturation level, infection, or nerve injury. We concluded that
self-administration of nitrous oxide combined with use of a hematoma block
is a safe and effective technique of analgesia for the outpatient reduction
of fractures in children.
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