Eff ectiveness of hematoma block versus general anesthesia in close reduction of distal radius fractures

Abstract

Objective: To compare eff ectiveness of hematoma block versus general anesthesia in close reduction of distal radius fractures. Study design: Randomized control tjrial. Place and duration of study: Department of Orthopedic Surgery, Lady Reading Hospital, Peshawar from June 2017 to December 2017. Material and Methods: Patients meeting the inclusion criteria and presenting to Accident and Emergency department were included in the study. Patients were randomly allocated to group-A (hematoma block) and group-B (general anesthesia) by randomization block method. Writt en informed consent was also obtained from all patients. Patient history and radiological assessment was done before anesthesia. Venous catheter was placed for all patients. Vital signs stability was evaluated in terms of pulse rate, respiratory rate, blood pressure, and oxygen saturation. General anesthesia was induced in all patients using propofol 1.5 - 2 mg/ kg, and sevofl urane (1% - 1.5%) in-oxygen was applied during general anesthesia. In hematoma block method, 10 mL of lidocaine 1% was injected into the fracture aft er aspiration of fracture hematoma. 10 mL of lidocaine 1% was injected into styloid radius and ulnar side as pinning locations. Th e maximum dose of 5 mg/kg was used for patients. Th e area was sterilized using povidone iodine 7.5% before injection. All patients were asked to fast for at least 6 hours. Manipulation through ligmentotaxis was carried out 15 minutes aft er hematoma block and immobilization by cast elbow in ulnar deviation was performed for all patients. For the patients in both groups, acetaminophen–codeine (500 mg/15 mg) tablet was prescribed for the pain aft er procedure, and 30 mg intravenous ketorolac was injected in case of severe pain. Pain intensity in patients was graded and based on visual analogue scale (VAS) in which the score 0 shows no pain and the score 10 indicates the worst imaginable pain. VAS-based pain grades and reduction was assessed aft er 6 hours of surgery. Results: As per eff ectiveness, in group-A, 34(68%) showed eff ectives results whereas in group -B, only 14(28%) patients showed eff ective results. Conclusion: We concluded that hematoma block is more eff ective than conscious sedation in close reduction of distal radius fracture in term of pain reduction.