Distal Radius Fracture
Conditions
Keywords
Hematoma block, distal radius fracture reduction, ultrasound, ultrasound guided hematoma block, traditional hematoma block for analgesia, bupivacaine, pain reduction, wrist fracture
Brief summary
The purpose of this study is to determine the efficacy of ultrasound guided hematoma block versus traditional "blind" hematoma block for analgesia in distal radius fracture reduction.
Detailed description
Hematoma blocks are safe and effective in providing analgesia for fracture reduction1-4. They involve injecting lidocaine directly into the fracture line for analgesia. The physician aspirates blood prior to injection to confirm placement in the hematoma created by the fracture. However, the procedure can be technically difficult if the fracture line is difficult to palpate, for example, due to significant swelling or body habitus. Ultrasound has been shown to improve efficacy in other analgesic procedures such as peripheral nerve blocks5 and also in identifying fracture lines6. There have been case reports and case series which have shown the feasibility and effectiveness of ultrasound guided hematoma blocks for analgesia in patients undergoing reduction for distal radius fractures7,8. To our knowledge there are no randomized controlled trials comparing the use of ultrasound guided hematoma blocks versus traditional hematoma blocks in achieving analgesia for distal radius fracture reduction. In this study, we will determine if ultrasound improves the efficacy of analgesia when performing hematoma blocks for reduction of distal radius fractures.
Interventions
OTHERultrasound guide
Patients randomized to this arm will have the hematoma block of the distal radial fracture with the guidance of a bedside ultrasound
Sponsors
Beth Israel Deaconess Medical Center
Harvard University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Adult patient ≥ 18 years old presenting to the emergency department with complaint of distal radius fracture
Exclusion criteria
* High acuity/distress per the Attending ED physician * Altered mental status or intoxication * Aphasia, mental retardation, dementia, or insurmountable communication barrier * Acute psychiatric illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Reduction as indicated by Visual Analog Scale | 4 hours after initiation of study procedure | Subjects will be surveyed on a Visual Analog Scale (VAS) on their pain during 4 points: prior to receiving hematoma block, after receiving hematoma block, during reduction and prior to discharge |
Countries
United States
Contacts
CONTACTBeatrice Hoffmann, MD
CONTACTNathan I Shapiro, MD MPH
PRINCIPAL_INVESTIGATORBeatrice Hoffmann, MD
Beth Israel Deaconess Medical Center
Outcome results
None listed