Hematoma Block Research Articles

Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study

BackgroundForearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block...

The Hematoma Block versus Hematoma Plus Wrist Nerve Block in the Reduction of Distal Radius Fractures

Abstract Background Distal radius fractures are extremely common. Most of them can be treated conservatively, but there are still many controversies about this nonoperative treatment. The purpose of this study was to assess whether the pain experienced during distal radius fracture reduction using the hematoma block plus a nerve block at the wrist is less than the perceived pain using an isolated hematoma block and whether the success of the closed reduction remains at least the same. Methods A total of 192 patients were included in a comparative study to assess whether the pain experienced during wrist fracture reduction using the hematoma block plus a nerve block at the wrist was less than using an isolated hematoma block and whether they were equally effective. Results The mean Visual Analog Scale (VAS) for pain at the wrist was 4.6 in the hematoma plus nerve block and 5.1 in the isolated hematoma block. The score at the fingers was 5.2 in the hematoma plus nerve block and 7.3 in the hematoma block. The success of the procedure was the same among groups. Conclusions The hematoma plus nerve block is more effective than the isolated hematoma block in reducing the pain during wrist fracture reduction, especially for fingers pain. The mean VAS was far from ideal and further focused research can be very useful because of the great clinical impact it can have. Level of Evidence Therapeutic study. Prospective cohort study—Level II.

Peripheral nerve blocks for closed reduction of distal radius fractures-A systematic review with meta-analysis and trial sequential analysis.

Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults. We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction. Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low. The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.

INTRA-ARTICULAR HAEMATOMA BLOCK VERSUS PROCEDURAL SEDATION FOR MANIPULATION OF CLOSED ANKLE FRACTURE DISLOCATIONS: AN EFFICACIOUS, RESOURCE-SPARING SOLUTION?

BackgroundProcedural sedation (PS) requires two suitably qualified clinicians and a dedicated monitored bed space. We present the results of intra-articular haematoma blocks (IAHB), using local anaesthetic, for the manipulation of closed ankle fracture dislocations and compared resource use with PS.MethodsPatients received intra-articular ankle haematoma blocks for displaced ankle fractures requiring manipulation between October 2020 to April 2021. The technique used 10ml of 1% lignocaine injected anteromedially into the tibiotalar joint. Pain scores (VAS), time from first x-ray to reduction, and acceptability of reduction were recorded. A comparison was made by retrospective analysis of patients who had undergone PS for manipulation of an ankle fracture over the six month period March – August 2020.ResultsDuring the periods assessed, 25 patients received an IAHB and 28 received PS for ankle fractures requiring manipulation (mean age 57.8yr vs 55.1yr). Time from first x-ray to manipulation was 65.9 min (IAHB) vs 82.9 min (PS) (p = 0.087). In the IAHB group mean pain scores pre, during and post manipulation were 6.1, 4.7 and 2.0 respectively (‘pre’ to ‘during’ p &lt; 0.05; ‘pre’ to ‘post’ p &lt; 0.01). In the IAHB group, 23 (92%) had a satisfactory reduction without need of PS or general anaesthetic. In the PS group 23 (82%) had a satisfactory reduction. There was no significant difference in the number of unsatisfactory first attempt reductions between the groups. There were no cases of deep infection post operatively in either group.ConclusionIntra-articular haematoma block of the ankle appears to be an efficacious, safe and inexpensive means of providing analgesia for manipulation of displaced ankle fractures. Advantages of this method include avoiding the risks of procedural sedation, removing the requirement of designated clinical space and need for qualified clinicians to give sedation, and the ability to re-manipulate under the same block.

No-anesthesia for Colles fracture

BackgroundThis study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block. MethodsWe employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process. ResultsFor fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s. ConclusionsThe reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults. Level of evidenceLevel I, Randomized Controlled Trial.

The occasional ultrasound-guided haematoma block and reduction for distal radius fractures

The occasional ultrasound-guided haematoma block and reduction for distal radius fractures

Hematoma Block Verses General Anesthesia For Close Reduction And Percutaneous Pinning Of Distal Radius Fractures In Elderly Patients

Objective: The objective of our study is to compare two techniques used for analgesia, hematoma block and general anaesthesia, in patients presented with a fracture of the distal radius in the trauma centre of Aziz Bhatti Shaheed Hospital Gujrat. Methods: Our study was conducted at the Trauma Centre of Aziz Bhatti Shaheed Hospital Gujrat from January 2021 to April 2023. All the patients having distal radius fractures who met the inclusion criteria were included in our study. The patients were placed into two groups, A and B. All the patients were treated by close reduction and percutaneous pinning. The analgesia method used in group A was Hematoma block while in group B was general anesthesia. Data was analyzed using SPSS. Results: 156 patients met the inclusion criteria. The mean age was 61.3 ± 6.6 years. These patients were placed in two groups, A and B, of 78 patients each. There was significantly less pain intensity at 2 and 6 hours after the procedure in the hematoma block group (P &lt; 0.001). Duration for manipulation did not differ significantly between the two groups. Duration for surgery was significantly shorter for the hematoma block group (P 0.02). In 100 per cent of cases, anatomical reduction was achieved in both groups. Conclusion: Hematoma block used as analgesia for the management of fractures of the distal radius in elderly patients is a more effective and safe method than general anaesthesia in emergency trauma centres. Keywords: Hematoma block, distal radius fracture, elderly.

Haematoma Block for Distal Radius Fracture Pain Management

Introduction: HB (Hematoma Block) is a commonly utilized technique all over the world to relieve discomfort during the management of DRF (Distal Radius Fractures). In this approach, 10ml to 15ml of 2 percent lignocaine, a topical anesthetic is utilized to reduce discomfort during the fracture reduction process. Materials &amp; Methods: In this study, we recruited fifty individuals between January and December of 2023. Every patient had a distal radius extra-articular fracture that required percutaneous pinning or plaster casting. HB using 12 to 15 ml of 2% lignocaine was administered to the patients for hematomas at the fracture site. Using the Visual Analogue Scale method, the patient's pain distribution and severity were measured before, during, and after the decrease. Findings: Before the HB, the average VAS (Visual Analogue Scale) score was 9.5. Less than two hours after the surgery and during reduction, the average VAS score dropped to 2.5 (range between 0.5 to 3.5). A scale of 0 to 10 cm is used to define the VAS scoring system. Conclusion: We found that HB is a safe and efficient technique of anesthetic in DRF where manipulation or reduction is necessary for pinning or casting.

Functional Outcome of Distal Radius Fractures in Elderly Treated By Close Reduction And Cast Application under Hematoma Block

Introduction: Distal radius fractures are common in elderly population. Various options of treatment are available. Very good clinical outcomes have been reported in elderly patients with distal radius fractures treated by close reduction and cast application. The purpose of this study was to assess functional outcome of distal radius fractures in elderly treated by close reduction and cast application under hematoma block. Methods: Sixty two patients (19 males,42 females; mean age 67.7± 5.7 years) aged &gt;60 years with distal radius fractures Frykman I to IV were treated with close reduction and cast application under hematoma block. Pain level was assessed using VAS score. Anatomical and functional results were assessed with radiological parameters, range of motion and DASH score at 2,6,12,24 and 52 weeks follow up. Results: Union was achieved in all fractures with mean time of 6.1±0.4weeks.At final follow up, mean radial height, radial inclination and radial tilt were 6.39 mm, 18.4°and 4.2° respectively. Mean VAS score and DASH score were 0.76 and 10.1 respectively. Complications were seen in 5 ( 6 % ) patients. Conclusion: Distal radius fractures in elderly treated by close reduction under hematoma block and cast application has good functional outcome.

Hematoma Block as an Alternate Mode of Anesthesia for Management of Extra-Articular Distal End Radius Fracture with Percutaneous K-Wire Fixation in Emergency Department.

Fractures of the distal end of the radius have a higher prevalence, particularly in older individuals, and typically necessitate a painful procedure of reduction by manipulation. Various regional blocks, including hematoma blocks, are used to manage this pain. Hematoma block is simple, effective, and safe, providing adequate analgesia without increasing post-procedural infection risks. This prospective study was conducted to observe and analyze the outcomes of 18 patients, aged from 18 to 65 years, who had displaced fractures in the distal end of the radius. These fractures were treated using percutaneous pinning under a hematoma block. The study measured the time from trauma to surgery, time for hematoma block administration, surgery duration, Visual Analog Scale (VAS) scores for pain preoperatively, intraoperatively, and postoperatively, reduction quality, and functional outcome using Mayo Wrist score and complications if any. The time from trauma to surgery was 31.44 ± 9.25 h. Hematoma block administration took 3.45 ± 1.34 min, and surgery duration was 29.16 ± 5.33 min. Pre-operative VAS was 6.39 ± 1.09, intraoperative VAS was 0.94 ± 0.54, and post-operative (3 h) VAS was 2.06 ± 0.80. The average pain-free duration postoperatively was 9.36 ± 3.21 h. Quality of reduction was excellent in 44.44% of cases and good in 38.89% of cases. Patients were discharged on average 4.19 ± 0.82 h after surgery. The functional outcome as noted by the Modified Mayo wrist score was excellent in 55.55% and poor in only 5.55% of cases. The hematoma block demonstrated effective post-operative pain control, comparable to the brachial plexus block. It provided significant perioperative pain relief, reduced hospital stay, and allowed for outpatient or daycare surgery. Hematoma block is a viable alternative for managing extra-articular distal end radius fractures in the emergency department, offering effective pain relief with minimal risk of complications. Further studies are needed to compare its efficacy with other anesthesia modalities.

Treatment of 5th Metecarpal Neck Fractures with Titanium Elastic Nail Using Local Anesthesia and Hematoma Block

Objective:Surgical treatment of 5th metacarp neck fractures using titanium elastic nail (TEN) is performed under general anesthesia or axillary block. In this study, our aim is to present the clinical and radiological results of patients who underwent surgery under local anesthesia for the TEN entry site and hematoma block for fracture reduction. Methods: There were 14 patients who met the inclusion criteria in the study. Radiologically, metacarpal shortness and volar angulation angles at the time of admission, after reduction in the ER and after surgical intervention when the fusion had been achieved were evaluated. Clinically, rotational deformity, range of motion of the affected finger were evaluated according to Quick DASH scores. Results: The volar angulation before and after reduction in ER was found to be as a mean of 46.2° (33-60°) and 40.6° (30-48°) respectively. After surgical intervention a mean of 17.2° (10-22°) was achived at the final follow-up. The metecarpal shortness was determined to be mean 4.4 mm (1.8-7.3mm) on first presentation, 3 mm (2-5 mm) after reduction in ER, and 2 mm (1.2-3.3mm) at the final follow-up examination in surgically treated group compared to healthy side. Radiological bone union was observed in mean 35 days, there was no pain on palpation, and the TEN was removed. Finger flexion and extension were determined to be full at the end of the 3rd month and no rotational defomity was observed. The mean Quick DASH score of the patients was 1.5 (1.2-2). Conclusion:5. metacarpal fractures with TEN under hematoma blockage and local anesthesia and leaving the proximal end out of the skin is a safe method for the treatment of such fractures.

Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial.

Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

Analgesic Techniques for Managing Orthopedic Injuries: A Review for the Emergency Clinician

BackgroundOrthopedic injuries are commonly managed in the emergency department (ED) setting. Fractures and dislocations may require reduction for proper management. There are a variety of analgesic and sedative strategies to provide patient comfort during reduction. ObjectiveThis narrative review evaluates hematoma block, intra-articular injection, intravenous regional analgesia (IVRA) (also known as the Bier block), and periosteal block for orthopedic analgesia in the ED setting. DiscussionAnalgesia is an essential component of management of orthopedic injuries, particularly when reduction is necessary. Options in the ED setting include hematoma blocks, intra-articular injections, IVRA, and periosteal blocks, which provide adequate analgesia without procedural sedation or opioid administration. When used in isolation, these analgesic techniques decrease complications from sedation and the need for other medications, such as opioids, while decreasing ED length of stay. Emergency clinicians can also use these techniques as analgesic adjuncts. However, training in these techniques is recommended prior to routine use, particularly with IVRA. ConclusionsKnowledge of analgesic techniques for orthopedic procedures can assist clinicians in optimizing patient care.

Comparison between the Effect of Lidocaine or Ropivacaine Hematoma Block and of Different Timings of Administration on Post-Operative Pain in Dogs Undergoing Osteosynthesis of Long-Bone Fractures.

We aimed to compare the efficacy of intra-operative lidocaine hematoma block (HB) to ropivacaine HB and to compare the efficacy of different timings of ropivacaine HB in controlling post-operative pain in dogs undergoing the osteosynthesis of long-bone fractures. We conducted a randomized, blinded, prospective clinical study. Forty-eight dogs with long-bone fractures were included and were randomly allocated to four groups: lidocaine (L), ropivacaine (Rmid), ropivacaine pre- (Rpre) and ropivacaine post- (Rpost) groups. The dogs in group L (n = 14) and in group Rmid (n = 11) received a lidocaine or ropivacaine HB, respectively, after fracture reduction and before osteosynthesis material placement. Rpre dogs (n = 11) received ropivacaine HB before fracture reduction, and Rpost dogs (n = 12) received ropivacaine HB after osteosynthesis material placement. Eight post-operative pain assessments were performed using the University of Melbourne Pain Scale (UMPS) and an algometer. Rescue analgesia was administered based on UMPS scoring. For data analysis, the Shapiro-Wilk test of normality, chi-square, Student t test and Split Plot analysis were used. The level of significance was set at α = 0.05. Rescue analgesia was administered to one dog in group L, one in group Rmid and one in group Rpost, with no significant differences detected. Compared to group Rmid, group L dogs exhibited significantly higher mean mechanical pain thresholds (p = 0.049) and lower mean UMPS scores (p = 0.001). Group Rpost dogs had statistically significantly higher mean pain thresholds compared to group Rmid (p = 0.009). When performed after fracture reduction and before osteosynthesis material placement, lidocaine HB seems to be more effective than ropivacaine HB in controlling post-operative pain in dogs undergoing osteosynthesis of long-bone fractures. The administration of ropivacaine HB after osteosynthesis material placement seems to be more effective than administration after fracture reduction and before osteosynthesis material placement or administration before fracture reduction in controlling post-operative pain in dogs undergoing osteosynthesis of long-bone fractures.

Efficacy of Hematoma Block after Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial.

To evaluate the efficacy of an intraoperative, post-fixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures. Prospective, double-blinded, randomized controlled trial. Academic Level I Trauma Center.Patients/Participants: 82 consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation. Patients were randomized to receive an intraoperative, post-fixation fracture hematoma injection containing either 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids. Visual analog scale (VAS) pain scores and opioid consumption. The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs 6.7, p=0.004), 0-8 hours (5.4 vs 7.0, p=0.013), 8-16 hours (4.9 vs 6.6, p=0.018), and 16-24 hours (4.7 vs 6.6, p=0.010) postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared to the control group over the first 24-hour postoperative period (43.6 vs 65.9, p=0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration. Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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

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.

Efficacy of Hematoma Block VS Conscious Sedation in Terms of Pain Relief for Manipulation and Reduction of Distal Radius Fracture

Objective: To compare the efficacy of hematoma block versus conscious sedation for closed reduction of distal radius fractures. Study Design and Setting: This was a Randomized Control Trial was conducted at Dr. Ziauddin University Hospital between 1st July 2018 and 31st July 2020. Methodology: A total of 158 patients underwent closed reduction of distal radius fractures in emergency department; these patients were divided in two groups of 79 each. Hematoma block was used as an analgesic in group A whereas conscious sedation was used on the patients in group B. Both groups were then compared for effectiveness in terms of pain reduction and SPSS software version 25 was used for data analysis. Results: Median age in group A was 44 years (IQR=37-48.5 years) and 40 years (IQR=30-47.50 years) in group B. The median pain score in group A [3 (IQR=2-5)] was significantly lesser than group B [5 (IQR=3-6)] with p=0.001. In group A effectiveness was achieved in patients was 69.6% and in group B effectiveness was achieved in patients was 35.44%. Statistically there was significant difference observed in proportion of efficacy between groups with p=0.001. Conclusion: This study show that hematoma block is more effective than conscious sedation in closed manual reduction of distal radius fractures in terms of pain relief.

Translated article] The haematoma block is not enough as method of anaesthesia in reduction of displaced distal radius fractures

BackgroundTwo out of three wrist fractures seen in an emergency department are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess pain during closed reduction of distal radius fractures after using haematoma block as method of anaesthesia. Patients and methodsCross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilisation during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analogue scale at different times of reduction and complications were registered. ResultsNinety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the haematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed. ConclusionsHaematoma block is only a mildly effective method to reduce wrist pain during closed reduction of distal radius fractures. This technique slightly decreases the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options.Level of evidence: Therapeutic study. Cross-sectional study – Level IV.

Regional Anesthesia as an Alternative to Procedural Sedation for Forearm Fracture Reductions in the Pediatric Emergency Department.

Pediatric forearm fractures are common injuries in the pediatric emergency department (PED). Pediatric procedural sedation (PPS) is often required for forearm fracture reductions and pain control for casting. Bier blocks and hematoma blocks are types of regional anesthesia (RA) procedures that can be performed as a potential alternative to PPS. The objective of this study is to compare the safety of RA with that of PPS. We hypothesized that RA has a safety profile that is equal or superior to PPS as well as a shorter duration of treatment in the PED. Pediatric emergency department encounters in patients presenting with a diagnosis of radius fracture, ulna fracture, distal "both-bone" fracture, Monteggia fracture, and/or Galeazzi fracture were included. Outcomes of interest included patient adverse events (AEs), sedation medications used, PED duration of treatment (arrival time to disposition time), sedation failures, and reduction failures. Propensity matching was performed resulting in 632 well-matched RA-PPS pairs. The PPS cohort had 13% of encounters with at least 1 AE compared with 0.2% in the RA cohort, P < 0.001. The most common AE in the PPS group was hypoxia (9.8%), and the only AE in the RA group was an intravenous infiltrate (0.16%). Within the matched cohorts, PPS required more medications than RA (100% vs 60%, P < 0.001). Ketamine alone was more commonly used in the PPS group than the RA group (86% vs 0.2%, P < 0.001). Propofol was used only in the PPS group. The average duration of treatment was 205 (SD, 81) minutes in the PPS group and 178 (SD, 75) minutes in the RA group ( P < 0.001). There were no reduction failures in either group. Bier blocks and hematoma blocks are an acceptable alternative to PPS for children requiring forearm reductions. The AE rate is low and the reduction success rate is high. Duration of treatment in the PED is shorter for patients receiving RA compared with PPS.

Safe and Effective Aspirations and Nerve Blocks for the On-Call Orthopaedic Surgeon.

The on-call orthopaedic surgeon is faced with a wide array of orthopaedic pathology for which intra-articular aspiration, injection, and/or nerve/hematoma block may be used. Efficient use of these diagnostic and therapeutic modalities affords better patient care and a more effective on-call period. Often, these interventions are the rate limiting factor in a reduction or diagnosis. In this review, we describe joint aspirations, saline load tests, hematoma blocks, and nerve blocks in detail to include their indications, techniques, related pharmacology, pearls, and pitfalls.