This study will investigate the effectiveness of analgesia of ultrasound hematoma block compared to 'blind' hematoma block in patients with dislocated distal radius fracture.
Distal radius fractures represent one of the most common injuries in the Emergency Department (ED). Proper treatment especially for dislocated fractures can minimize the chance of residual injury. For closed reduction anesthesia is essential for safety, satisfaction and result. Different methods of regional anesthesia can be used but hematoma block (HB) is the technique most often used in EDs in the Netherlands and recommended by Dutch guidelines. In practice however a HB, does not always lead to adequate anesthesia, this might be because of poor infiltration into the fracture site. Ultrasound could additionally provide real-time guidance of injection into the fracture site, maximizing the analgesic effect of HB. In this study the effectiveness of analgesia of ultrasound HB will be compared to 'blind' HB in patients with a dislocated distal radius fracture. Patients with a confirmed dislocated fracture of the distal radius requiring closed reduction will be randomized to either ultrasound guided hematoma block or normal 'blind' hematoma block. NRS-scores will be given before, during and after hematoma block and during and after reduction of the fracture. These scores will be the primary endpoint of this study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Patients with a dislocated fracture of the distal radius will receive ultrasound guided hematoma block with 10mL lidocaine 2% to get real-time guidance of the given anesthesia into the fracture site before closed reduction of a distal radius fracture.
Patients with a distal radius fracture will receive standard treatment; hematoma block with 10mL 2% lidocaine performed with palpation of the fracture site (blind hematoma block) before closed reduction of dislocated distal radius fractures.
Medisch Centrum Leeuwarden
Leeuwarden, Provincie Friesland, Netherlands
RECRUITINGEffectiveness of analgesia during closed reduction of a distal radius fracture
Pain reduction will be measured on a Numeric Rating Scale( NRS-scale; 0-10) at different moments
Time frame: NRS before, during and after (10-15 min) injection of hematoma block, NRS-score during closed reduction and after closed reduction (5 min)
Number of participants in which hematoma was aspirated during hematoma block
Measure of correct position of hematoma block if there is aspiration of blood (yes/no)
Time frame: During hematoma block
Procedural time of the Hematoma block
Time needed to perform HB (blind or ultrasound-guided; from moment of localization of the fracture until the moment the needle is out of the patient)
Time frame: Time from insertion of the needle until needle is withdrawn out of the patient (up to maximum of 30 min.)
Procedural time of the reduction
Time needed to perform reduction of the fracture
Time frame: From moment physician is ready to start the reduction until cast is applied (up to maximum of 30 min.)
Satisfaction of the HB provided by physician performing the HB procedure
measured on a 5-points Likert-scale (Very satisfied, Somewhat satisfied, Neither satisfied nor dissatisfied, Somewhat dissatisfied or Very dissatisfied)
Time frame: 10-15 minutes after hematoma block
Satisfaction of reduction provided by physician performing reduction measured
measured on a 5-points Likert-scale (Very satisfied, Somewhat satisfied, Neither satisfied nor dissatisfied, Somewhat dissatisfied or Very dissatisfied)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 10-15 minutes after closed reduction
Satisfaction of the patient for procedure and reduction
measured on a 5-points Likert-scale (Very satisfied, Somewhat satisfied, Neither satisfied nor dissatisfied, Somewhat dissatisfied or Very dissatisfied)
Time frame: 10-15 minutes after closed reduction
Satisfaction of the nurse for procedure and reduction
measured on a 5-points Likert-scale (Very satisfied, Somewhat satisfied, Neither satisfied nor dissatisfied, Somewhat dissatisfied or Very dissatisfied)
Time frame: 10-15 minutes after closed reduction
Number of reductions
Defined as attempt(s) to align fracture and application of cast
Time frame: (up to) 10-15 minutes after last closed reduction attempt
Years of experience of treating physician in performing HB.
Years of experience of treating physician in performing HB.
Time frame: (up to) 10-15 minutes after last closed reduction attempt
Years of experience of treating physician with use of ultrasound.
Years of experience of treating physician with use of ultrasound.
Time frame: (up to) 10-15 minutes after last closed reduction attempt
Number of patients in which palpation of an evident step-off near fracture site was felt
Before performing hematoma block performing physician will palpate if there is a clear step-off near the fracture site (important especially in blind hematoma group)
Time frame: During performing hematoma block