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Although ketamine has been shown to be effective for emergency (ED) fracture reduction (FR) in children, adverse effects (AE) and prolonged recovery times limit its use. To compare the efficacy and AE of ketamine/midazolam (K) vs nitrous oxide/hematoma block (N) for analgesia during forearm FR in children. Children 4-18 years old were randomized to receive IV ketamine (1 mg/kg)/midazolam (0.1 mg/kg); max= 2.5 mg) or 50% nitrous oxide/O 2 and a hematoma block with lidocaine. All received oxycodone 0.2 mg/kg (max= 15 mg) at least 45 mins prior to FR. Videos were obtained before (baseline (B)), during, and after FR and later scored by a blinded observer using the Procedure Behavioral Checklist (PBCL). The primary outcome measure was the mean change in PBCL scores from B to intra-procedure, with greater change from B indicating greater procedure distress. Secondary …