Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(04): e557-e562
DOI: 10.1055/s-0043-1768623
Artigo Original
Anestesiologia

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius[*]

Article in several languages: português | English
Guilherme de Albuquerque Souza Maia 
1   Aluno de mestrado, Programa de Ciências da Saúde Aplicadas ao Aparelho Locomotor da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Jean Castro Cunha 
2   Residente do terceiro ano, Departamento de Ortopedia e Traumatologia da Santa Casa de Ribeirão Preto, Ribeirão Preto, SP, Brasil
,
Carolina Queiroz Feijó 
3   Estudante de medicina, Faculdade de Medicina da Universidade Estadual do Piauí, Teresina, PI, Brasil
,
Daniel Mendes Leal 
4   Ortopedista, Programa de residência médica da Santa Casa de Ribeirão Preto, Ribeirão Preto, SP, Brasil
,
Juan Javier Moreira 
4   Ortopedista, Programa de residência médica da Santa Casa de Ribeirão Preto, Ribeirão Preto, SP, Brasil
,
Carlos Fernando Pereira da Silva Herrero 
5   Médico Ortopedista, Cirurgião de Coluna, Professor Doutor, Departamento de Ortopedia e Anestesiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
› Author Affiliations Financial Support There was no financial support from public, commercial, or non-profit sources.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block.

Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction.

Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1–10) and 3.50 (-6–10) in difference 1; 4.35 (-5–10) and 5.00 (-3–10) in difference 2; and 4.65 (1–10) and 3.80 (-3–10) in difference 3.

Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Keywords

anesthesia, local - closed fracture reduction - nerve block - radius fractures - pain measurement

* Study developed at Santa Casa de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil




Publication History

Received: 07 June 2022

Accepted: 18 October 2022

Article published online:
30 August 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Tornetta III P, Ricci W, Ostrum RF, Court-Brown CM, McQueen M, McKee M. Eds. Rockwood and Green's fractures in adults. 9th ed. Philadelphia: Wolters Kluwer; 2020
    Search in Google Scholar
  • 2 Browner BD, Jupiter J, Krettek C, Anderson P. Skeletal trauma: basic science, management, and reconstruction. 6th ed. St. Louis, MO: Elsevier; 2019
    Search in Google Scholar
  • 3 Waters PM, Skaggs DL, Flynn JM. Eds. Rockwood and Wilkins' fractures in children. 9th ed. Philadelphia: Wolters Kluwer; 2020
    Search in Google Scholar
  • 4 Myderrizi N, Mema B. The hematoma block an effective alternative for fracture reduction in distal radius fractures. Med Arh 2011; 65 (04) 239-242
    CrossrefPubMedSearch in Google Scholar
  • 5 Frenkel O, Herring AA, Fischer J, Carnell J, Nagdev A. Supracondylar radial nerve block for treatment of distal radius fractures in the emergency department. J Emerg Med 2011; 41 (04) 386-388
    CrossrefPubMedSearch in Google Scholar
  • 6 Thakkar CV. Hematoma block: An effective anesthesia for distal radius fractures. International J Orthop Sci 2019; 5 (02) 347-349
    CrossrefSearch in Google Scholar
  • 7 Aydin AA, Bilge S, Kaya M, Aydin G, Cinar O. Novel technique in ED: supracondylar ultrasound-guided nerve block for reduction of distal radius fractures. Am J Emerg Med 2016; 34 (05) 912-913
    CrossrefPubMedSearch in Google Scholar
  • 8 Waldman SD. Atlas of interventional pain management. 4th ed. Philadelphia: Saunders; 2015
    Search in Google Scholar
  • 9 Arslanian B, Mehrzad R, Kramer T, Kim DC. Forearm Bier block: a new regional anesthetic technique for upper extremity surgery. Ann Plast Surg 2014; 73 (02) 156-157
    CrossrefPubMedSearch in Google Scholar
  • 10 Koren L, Ginesin E, Elias S, Wollstein R, Israelit S. The Radiographic Quality of Distal Radius Fracture Reduction Using Sedation Versus Hematoma Block. Plast Surg (Oakv) 2018; 26 (02) 99-103
    CrossrefPubMedSearch in Google Scholar
  • 11 Obata H, Naito K, Sugiyama Y. et al. Surgical Treatment of Distal Radius Fractures under the Ultrasound-Guided Brachial Plexus Block Performed by Surgeons. J Hand Surg Asian Pac Vol 2019; 24 (02) 147-152
    CrossrefPubMedSearch in Google Scholar
  • 12 Lew E, Vloka JD, Hadžić A. Ropivacaine for peripheral nerve blocks: Are there advantages?. Tech Reg Anesth Pain Manage 2001; 5 (02) 56-59
    CrossrefSearch in Google Scholar
  • 13 Orbach H, Rozen N, Rinat B, Rubin G. Hematoma block for distal radius fractures - prospective, randomized comparison of two different volumes of lidocaine. J Int Med Res 2018; 46 (11) 4535-4538
    CrossrefPubMedSearch in Google Scholar
  • 14 Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63 (Suppl 11): S240-S252
    CrossrefPubMedSearch in Google Scholar
  • 15 Kakarlapudi TK, Santini A, Shahane SA, Douglas D. The cost of treatment of distal radial fractures. Injury 2000; 31 (04) 229-232
    CrossrefPubMedSearch in Google Scholar
  • 16 Orland KJ, Boissonneault A, Schwartz AM, Goel R, Bruce Jr RW, Fletcher ND. Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department. JAMA Netw Open 2020; 3 (02) e1921202
    CrossrefPubMedSearch in Google Scholar
  • 17 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; 15 (01) 351
    CrossrefPubMedSearch in Google Scholar
  • 18 Younge D. Haematoma block for fractures of the wrist: a cause of compartment syndrome. J Hand Surg [Br] 1989; 14 (02) 194-195
    CrossrefPubMedSearch in Google Scholar
  • 19 Barash PG, Cahalan MK, Cullen BF. Clinical anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017
    Search in Google Scholar
  • 20 Eldawlatly A, Rikabi AA, Elmasry S. Safety of intraneural injection of local anesthetic. Saudi J Anaesth 2013; 7 (01) 80-82
    CrossrefPubMedSearch in Google Scholar
  • 21 Bear DM, Friel NA, Lupo CL, Pitetti R, Ward WT. Hematoma block versus sedation for the reduction of distal radius fractures in children. J Hand Surg Am 2015; 40 (01) 57-61
    CrossrefPubMedSearch in Google Scholar
  • 22 Drake RL, Vogl AW, Mitchell A. Gray's anatomy for students. 4th ed. Philadelphia, MO: Elsevier; 2019
    Search in Google Scholar