救急部における小児前腕骨折の閉鎖的縮小のためのSedoanalgesiaとInfraclicular Blockの比較。プロスペクティブ無作為化試験

Sedoanalgesia Versus Infraclavicular Block for Closed Reduction of Pediatric Forearm Fracture in Emergency Department: Prospective Randomized Study.

• Selahattin Karagoz
• Erdal Tekin
• Muhammed Enes Aydin
• Mehmet Cenk Turgut
• Ahmet Murat Yayik

抄録

目的:

手続き的鎮痛は、介入的処置、診断、および治療のために救急部（ED）の小児患者で一般的に使用されています。しかし，この方法では，呼吸器系や心筋梗塞などの重篤な全身合併症を引き起こす．これらの合併症を最小限に抑えるために，近年，超音波ガイド下局所麻酔法が用いられるようになってきている．我々は、前腕骨折の閉鎖的縮小術を受けた小児患者の疼痛管理において、手続き的鎮静麻酔（PSA）と鎖骨下ブロック（ICB）の使用を比較することを目的とした。

OBJECTIVE: Procedural sedoanalgesia is commonly used in pediatric patients in the emergency department (ED) for interventional procedures, diagnosis, and treatment. However, this method causes serious systemic complications, such as respiratory and cardiac depression. To minimize these complications, ultrasound-guided regional anesthesia methods have been used in recent years. We aimed to compare the use of procedural sedoanalgesia (PSA) and infraclavicular block (ICB) in the pain management of pediatric patients who underwent closed reductions of forearm fractures.

材料および方法:

この前向き無作為化臨床試験は、前腕骨折でEDに来院した3～15歳の患者を対象とした。患者は2つのグループに分けられた：手続き的鎮静鎮痛群（PSA群、n = 30）と超音波ガイド下ICB群（ICB群、n = 30）。手技前および手技中の疼痛スコアをWong-Baker FACES Scaleを用いて評価した。疼痛スコアと親と操作者の満足度をグループ間で比較した。

MATERIALS AND METHODS: This prospective, randomized, clinical study included patients aged 3 to 15 years who presented to the ED with forearm fractures. The patients were divided into 2 groups: the procedural sedoanalgesia group (group PSA, n = 30) and ultrasound-guided ICB group (group ICB, n = 30). Pain scores of the patients were evaluated using the Wong-Baker FACES Scale before and during the procedure. Pain scores and parental and operator satisfaction were compared between the groups.

結果:

人口統計学的には統計的有意性は認められなかった。手技中に観察された疼痛スコアは、ICB群よりPSA群の方が有意に高かった（それぞれ3.07±1.55 vs 0.47±0.86、P＜0.001）。ICB群の親の満足度および操作者の満足度は、PSA群よりも有意に高かった(P < 0.001)。

RESULTS: There was no statistical significance in terms of demographic data. The pain scores observed during the procedures were significantly higher in the group PSA than in the group ICB (3.07 ± 1.55 vs 0.47 ± 0.86, respectively; P < 0.001). The parental and operator satisfaction of the ICB group was significantly higher than that of the PSA group (P < 0.001).

結論:

超音波誘導型ICBは、EDの小児患者の前腕骨折閉鎖縮小術時の疼痛管理に安全かつ効果的な方法です。救急救命室で安全に使用でき、親と術者の満足度も高い。

CONCLUSIONS: Ultrasound-guided ICB is a safe and effective method in the management of pain during closed reduction of forearm fracture in pediatric patients in EDs. It can be used safely in emergency rooms and has a high level of both parental and operator satisfaction.