• Alex Kwong, Emogene S Aldridge, Rachith Jayawardana, Anna Brookwick, Joseph Miller, and Paul G Buntine.
• Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2022 Feb 1; 34 (1): 73-77.

ObjectiveTo compare length of stay (LOS) for paediatric patients receiving ketamine sedation or Bier's block anaesthesia for procedural closed fracture reduction.MethodsWe conducted a retrospective audit of paediatric ED patients aged 3-18 years presenting at one of three metropolitan hospitals in Victoria, Australia (2012-2017). Outcomes were post-procedural LOS (PPLOS), total LOS, incidence of ketamine and Bier's block procedures, and recorded adverse effects. Groups were compared using t-tests. Association between treatment group and admission to a short stay unit (SSU) was assessed using univariate logistic regression.ResultsAcross all three sites, 449 patients were included, 379 of whom received ketamine sedation and 73 of whom underwent Bier's block anaesthesia. Mean age was 9.1 years (ketamine group: 8.3 years; Bier's block group: 13.1 years). Median PPLOS was 75 min shorter for patients who received a Bier's block than for those sedated with ketamine (P < 0.001). Patients sedated with ketamine were also 9.01 times more likely to be admitted to an SSU than those who received Bier's block anaesthesia (95% confidence interval 3.82-21.31, P < 0.001). Ketamine sedation was more common than Bier's block across the three sites. No major adverse events occurred in either group.ConclusionBier's block anaesthesia is a safe alternative to ketamine sedation for paediatric patients presenting to the ED with closed fractures. It is associated with reduced LOS and need for post-procedural observation. However, ketamine may remain preferable for younger paediatric patients, on whom it places fewer demands for cooperation.© 2021 Australasian College for Emergency Medicine.

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