Abstract
Introduction: Distal radius fractures are one of the commonest fractures and more commonly involve children and elderly. Analgesia during reduction are determined by safety, simplicity, effectiveness and costs. The objective of this study is to evaluate the effectiveness of the Hematoma Block (HB) for reduction in distal forearm fractures in a developing country like Nepal.
 Methods: The study design was double blind randomized control trial performed at tertiary care hospital from July 2016 to August 2017. The patients having radiologically confirmed distal forearm fractures less than 96 hours old in 46 males and 54 females included after obtaining informed consent. 50 patients receiving Brachial Plexus Block (BPB group), and 50 patients receiving HB group during reduction of distal forearm fractures were initially allotted in two arms of randomized group. Pain measured by Visual Analogue Scale (VAS) was recorded before, during, and after reduction.
 Results: The study showed that HB with (mean ± SD) a VAS score of 2.08 ± 0.85 was as effective as BPB with a VAS of 1.7 ± 0.64 in terms of producing analgesia ( p=0.013), with the advantage of no motor paralysis and a significantly higher reduction rate, odds 3.45, 95% CI 1.52 – 7.85, p = 0.0013. 1/50 patients in brachial plexus block had bronchospasm needing intubation and ICU care where as 1/50 patient with hematoma block and infection which needed incision drainage and external fixation for complete healing.
 Conclusions: “The Hematoma Block” is to be encouraged in our set up for the reduction of the distal forearm fractures. The technique may be used in those fractures like isolated ulna fractures, minially displaced tibial fractures, fracture fibula where local anesthesia can be easily infiltrated percutaneously The study may be beneficial in managing such fractures and hence, it will help change in therapeutic policies comparing other modalities.
Highlights
Distal radius fractures are one of the commonest fractures and more commonly involve children and elderly
13 An increasing awareness of cost and time with the National Health Service contributes to a marked change in the anesthetic management of Colles’ fractures, and demonstrates the increasing popularity of the Hematoma Block in term of the expenses incurred by the general anesthesia for fracture reduction
21 The pain relief during reduction measured by Visual analogue scale, the acceptability of reduction in terms of post reduction radiographic configuration and complications associated with the type of anesthesia used are three main aspects of this study
Summary
Distal radius fractures are one of the commonest fractures and more commonly involve children and elderly. Analgesia during reduction are determined by safety, simplicity, effectiveness and costs. The objective of this study is to evaluate the effectiveness of the Hematoma Block (HB) for reduction in distal forearm fractures in a developing country like Nepal. Fractures of the distal radius are one of the commonest fractures, accounting for one sixth of all fractures seen in emergency rooms. They more commonly involve children and elderly. The characteristic features of ideal analgesia during reduction are determined by safety, simplicity, effectiveness and costs. Hematoma Block (HB) alone, HB with sedation, Bier’s Block (Intravenous regional anesthesia), regional nerve blocks, sedation have
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