Ultrasound Guided Supracondylar Nerve Block & Hematoma Block for Closed Reduction of Distal End Radius Fractures
Study Details
Study Description
Brief Summary
Comparison of analgesia between ultrasound guided supracondylar radial nerve block and hematoma block for closed reduction of distal end radius fractures- an observational study
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
A patient who presents to the emergency department with a suspected distal end radius fracture will be assessed with a baseline NRS score1 and given analgesics if needed. Further they will be sent for an x-ray. If the X ray-shows a distal end radius fracture a decision to give hematoma block or supracondylar radial nerve block will be taken as per the choice of the treating physician. Patients who do not meet the exclusion criteria are excluded from the study at this phase. NRS score 2 is assessed once again prior to block and a Hematoma block/ Supracondylar radial nerve block is given. Needle in and out time will be noted and the pain during needling is evaluated using the NRS score 3. Pain score will further be evaluated for every 10 mins after needle out time for a maximum of 30 mins or when the patient gets adequate analgesia ( NRS score 4a, 4b, 4c, 4d).
If the block is successful, the treating physician will proceed to fracture reduction. If the block is a failure the physician will go for a rescue analgesia. NRS score5 will be evaluated at this stage. Further a NRS score 6 will be assessed 15 minutes post reduction. An x-ray will be checked for the evaluation of the reduction procedure performed and the patient will be discharged or admitted as necessary. The patient will be further followed after 1 week for delayed complications.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Adults >18 years with distal end radius fracture Adults > 18 years with distal end radius fracture requiring closed reduction in Emergency Department |
Other: Hematoma block
A patient who presents to the emergency department with a suspected distal end radius fracture , will be sent for an x-ray. If the X ray-shows a distal end radius fracture a decision to give hematoma block will be taken as per the choice of the treating physician. Patients who do not meet the exclusion criteria are excluded from the study at this phase.
Other: Supracondylar radial nerve block
A patient who presents to the emergency department with a suspected distal end radius fracture will be assessed with a baseline NRS score1 and given analgesics if needed. Further they will be sent for an x-ray. If the X ray-shows a distal end radius fracture a decision to give supracondylar radial nerve block will be taken as per the choice of the treating physician. Patients who do not meet the exclusion criteria are excluded from the study at this phase.
|
Outcome Measures
Primary Outcome Measures
- To compare analgesic effect of supracondylar radial nerve block with hematoma block under ultrasound guidance in closed reduction of distal end radius fractures in emergency department assessed using numerical rating scale. [60 minute]
To compare analgesic effect of supracondylar radial nerve block with hematoma block under ultrasound guidance in closed reduction of distal end radius fractures in emergency department assessed using numerical rating scale during before closed reduction, during reduction & after closed reduction.
Secondary Outcome Measures
- To compare time taken for performing hematoma block & supracondylar radial nerve block [60minute]
To compare the time taken for hematoma block & supracondylar radial nerve block for closed reduction of distal end radius fracture. Time is noted from needle in to needle out for both technique.
- To compare time taken for analgesic effect of hematoma block & supracondylar radial nerve block for closed reduction of distal end radius fracture [60minute]
compare the analgesic effects of both technique ,which reduces the pain score more during the closed reduction
- To compare complication rates of hematoma block & supracondylar radial nerve block for closed reduction of distal end radius fracture [18months]
Compare the immediate & delayed complications upto 7 days after the procedure
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults > 18 years with distal end radius fracture requiring closed reduction in Emergency Department
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Patient who legally consent for study
Exclusion Criteria:
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History of allergy to local anesthetics
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Pregnant or lactating women
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Infection or burn with local anaesthetic at injection site
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Patients having other fractures or significant injuries that are causing pain
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Patients with hemodynamic instability which includes patients with GCS score less than 15 under influence of alcohol/ inebriated state.
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Patients on anticoagulants
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Patients with compromised neurovascular system
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Emergency Medicine Department of Jubilee Mission Medical College & Research Institute, Thrissur | Thrissur | Kerala | India | 680 005 |
Sponsors and Collaborators
- Jubilee Mission Medical College and Research Institute
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Ultrasound guided haematoma block may be a safe and effective alternative to procedural sedation and analgesia.
- ultrasound guided radial nerve block is safe
Publications
- Fathi M, Moezzi M, Abbasi S, Farsi D, Zare MA, Hafezimoghadam P. Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial. Emerg Med J. 2015 Jun;32(6):474-7. doi: 10.1136/emermed-2013-202485. Epub 2014 Jul 12.
- Maleitzke T, Plachel F, Fleckenstein FN, Wichlas F, Tsitsilonis S. Haematoma block: a safe method for pre-surgical reduction of distal radius fractures. J Orthop Surg Res. 2020 Aug 26;15(1):351. doi: 10.1186/s13018-020-01819-y.
- Tabrizi A, Mirza Tolouei F, Hassani E, Taleb H, Elmi A. Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency. Anesth Pain Med. 2016 Nov 27;7(1):e40619. doi: 10.5812/aapm.40619. eCollection 2017 Feb.
- Unluer EE, Karagoz A, Unluer S, Kosargelir M, Kizilkaya M, Alimoglu O, Akoglu H, Aslan C. Ultrasound-guided supracondylar radial nerve block for Colles Fractures in the ED. Am J Emerg Med. 2016 Aug;34(8):1718-20. doi: 10.1016/j.ajem.2016.06.007. Epub 2016 Jun 8. No abstract available.
- 40/22/IEC/JMMC&RI