Photo: Bryan Goodchild
A new multicenter study led by Zachary Binder, MD, associate professor of pediatrics, provides compelling evidence that an ultrasound-guided nerve block can dramatically improve pain control for children with femur fractures, while reducing their need for opioids by nearly 75 percent.
Published in Academic Emergency Medicine, the study is the first large, prospective evaluation of the technique in pediatric emergency settings and offers a promising new approach to managing one of childhood’s most painful injuries.
Unlike many broken bones that can be stabilized quickly and treated on an outpatient basis, femur fractures require surgery. Children may spend up to 12 hours or longer waiting in the emergency department before an operating room is available.
“Traditionally, these kids receive intermittent doses of IV opioids,” Dr. Binder said. “Sometimes it helps, sometimes it doesn’t, and opioids bring risks—both short-term and long-term. We knew we needed something better.”
The study evaluated whether a targeted nerve block, delivered using ultrasound to place numbing medication precisely around the femoral nerve, could offer safer and more consistent relief.
Binder and 11 colleagues across the U.S. and Australia enrolled 114 children with femur fractures between 2022 and 2024—nearly double the number originally needed to power the study. The findings were significant:
- Pain scores dropped 3.8 points (on a 0–10 scale) within one hour for children who received a nerve block, compared to 0.8 points for those receiving standard IV opioids.
- Pain control remained superior four hours later.
- Opioid use was decreased by 73 percent in children who received nerve blocks while awaiting surgery.
- No increase in complications or adverse events was seen.
- Emergency department length of stay was the same for both groups.
“Now that we have published evidence, we can tell parents confidently that nerve blocks give better pain relief and reduce opioid exposure without adding risk,” Binder said. “That matters tremendously when families are trying to make care decisions in stressful moments.”
Using point-of-care ultrasound, clinicians visualize the femoral nerve and guide a needle to inject numbing medication directly around it, blocking pain at its source.
Binder also serves as ultrasound director for the Medical School, helping to oversee UMass Chan’s progressive point-of-care ultrasound curriculum during which all pre-clinical medical students receive hands-on training.
“This is a well-established technique in the operating room,” he said. “Point-of-care ultrasound lets us bring that level of precision right to the bedside in the emergency department.”
Because few pediatric emergency physicians are trained in regional anesthesia, the technique has not yet become common practice. Binder hopes this study will help change that.
“It should be a standard of care for children with broken legs,” he said. “To get there, we need widespread training for emergency clinicians.”
He noted that the technique may be even more valuable in settings with limited resources.
“I spent a month working in Haiti, where children with fractures sometimes waited weeks for surgery,” he said. “A safe, effective way to control pain—without heavy reliance on opioids—could be life-changing.”
Early analysis of parent and caregiver surveys also shows overwhelmingly positive experiences, and additional publications are planned. But Binder’s focus is on making sure the research changes practice.
“My colleagues and I are already teaching courses around the country,” he said. “When we see how dramatically this improves a child’s pain, it motivates us to help make nerve blocks a routine part of pediatric emergency care.”
