Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial

Fathi, Marzieh; Moezzi, Meisam; Abbasi, Saeed; Farsi, Davood; Zare, Mohammad; Hafezimoghadam, Peyman

doi:10.1136/emermed-2013-202485

Cited by 32 publications

(30 citation statements)

References 17 publications

(11 reference statements)

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“…After screening the titles and abstracts and removing duplicates, we identified 465 potentially relevant studies. After full‐text review, 55 articles met inclusion criteria . Interobserver agreement (kappa) for phase II of the review was 0.99 (95% CI = 0.98 to 1.0).…”

Section: Resultsmentioning

confidence: 99%

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Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Bellolio

Gilani

Barrionuevo

et al. 2016

Academic Emergency Medicine

119

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ObjectivesThis was a systematic review and meta‐analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED).MethodsEight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included. Meta‐analysis was performed using a random‐effects model and reported as incidence rates with 95% confidence intervals (CIs).ResultsThe search yielded 2,046 titles for review. Fifty‐five articles were eligible, including 9,652 procedural sedations. The most common adverse event was hypoxia, with an incidence of 40.2 per 1,000 sedations (95% CI = 32.5 to 47.9), followed by vomiting with 16.4 per 1,000 sedations (95% CI = 9.7 to 23.0) and hypotension with 15.2 per 1,000 sedations (95% CI = 10.7 to 19.7). Severe adverse events requiring emergent medical intervention were rare, with one case of aspiration in 2,370 sedations (1.2 per 1,000), one case of laryngospasm in 883 sedations (4.2 per 1,000), and two intubations in 3,636 sedations (1.6 per 1,000). The incidence of agitation and vomiting were higher with ketamine (164.1 per 1,000 and 170.0 per 1,000, respectively). Apnea was more frequent with midazolam (51.4 per 1,000), and hypoxia was less frequent in patients who received ketamine/propofol compared to other combinations. The case of laryngospasm was in a patient who received ketamine, and the aspiration and intubations were in patients who received propofol. When propofol and ketamine are combined, the incidences of agitation, apnea, hypoxia, bradycardia, hypotension, and vomiting were lower compared to each medication separately.ConclusionsSerious adverse events during procedural sedation like laryngospasm, aspiration, and intubation are exceedingly rare. Quantitative risk estimates are provided to facilitate shared decision‐making, risk communication, and informed consent.

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Section: Resultsmentioning

confidence: 99%

“…Forest plot of the proportion of patients experiencing hypotension, by medication. E = etomidate; K = ketamine; KP = ketamine/propofol; M = midazolam; MO = midazolam/opiate; P = propofol …”

Section: Resultsmentioning

confidence: 99%

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Bellolio

Gilani

Barrionuevo

et al. 2016

Academic Emergency Medicine

119

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“…In the latest study by Myderrizi and Mema in 2011 ( 5 ) conducted on patients with distal radius fractures, hematoma block was safer and more efficient than general anesthesia and intravenous injection of anesthesia drugs for closed reduction of distal radius fracture although treatment failure was not different between two methods. In the study of Fathi et al ( 21 ) regarding pain control in acute distal radial fracture reduction, ultrasound guided haematoma block was recognized as a safe and effective method compared to procedural sedation and analgesia. Four patients (5.5%) in the procedural sedation and analgesia group showed early adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency

et al. 2016

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BackgroundDistal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group.ObjectivesThe aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department.Methods68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis.Results68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference.ConclusionsHematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments.

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“…16 Dezfuli et al has described maximum recommended doses of both lignocaine as well as bupivacaine for HB. 17 Researchers have used varied concentrations of 1-10% lignocaine and even prilocaine 6,8,9,18 ; however, all studies have used a fixed volume dose. There is a potential concern related to use of combination of LA and their total dose.…”

Section: Discussionmentioning

confidence: 99%

“…7,24,25 There has been renewed interest in HB as the technique is performed using of ultrasound for guidance and adjuncts for the HB. 18,25 Even though HB is safe, a case of osteomyelitis and a case of compartment syndrome have been reported. 26,27 In our study, not a single case of surgical site infection or osteomyelitis was noted during a 90-day follow-up of the cases.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

Verma

Hasnain

Sreevastava

et al. 2016

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 2 ( 2 0 1 6 ) 2 4 7 -2 5Methods: An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.Results: 100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery. Conclusion:The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications. #

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Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial

Abstract: 201112308104N5.

Cited by 32 publications

References 17 publications

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency

Anaesthetic management of forearm fractures using a combination of haematoma block and intravenous regional anaesthesia

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