Haematoma block: Assessment of postoperative analgesic effect following manipulation of distal forearm fractures

Abstract

Abstract Haematoma block has been shown to provide a safe and effective method of analgesia for the manipulation of wrist fractures in adults, 1 but has previously been little used in paediatric anaesthetic practice. There is little published data on the use of this technique for postoperative analgesia. The aim of this study was to assess the efficacy of haematoma block in providing postoperative analgesia in children following manipulation of distal forearm fractures. Forty healthy children with fractures of the distal radius and ulna were randomised to one of two groups. Against the background of a standard general anaesthetic, the patients were randomly allocated to receive either 1 ml of normal saline per 10 kg body weight or 1 ml of 0.25% bupivacaine per 10 kg of body weight injected into the fracture site under general anaesthesia prior to manipulation of the fracture. Clinical staff were unaware as to the nature of the injected solution. The two groups were compared in terms of postoperative analgesic requirements, the time to first analgesia, and in terms of half hourly pain and sedation scores. The children in the bupivacaine group had significantly lower pain scores throughout the whole study period. The median pain scores for the bupivacaine group were significantly better at 30, 60 and 90 minutes. The median time to first analgesia was 120 minutes for the bupivacaine group and 90 minutes for the saline group. This study shows that intraoperative haematoma block with 0.25% bupivacaine improves pain scores in the early postoperative period and prolongs the time to first analgesia.