There was insufficient robust evidence from randomised trials to establish the relative effectiveness of different methods of anaesthesia, different associated physical techniques or the use of drug adjuncts in the treatment of distal radial fractures. There is, however, some indication that haematoma block provides poorer analgesia than IVRA, and can compromise reduction.
Given the many unresolved questions over the management of these fractures, we suggest an integrated programme of research, which includes consideration of anaesthesia options, is the way forward.
A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius.
The aim of this study was to compare prospectively haematoma blocks alone and haematoma blocks with sedation with general anaesthesia for the reduction of distal radius fractures in adult patients, with respect to pain perception before, during and after manipulation using a visual analogue scale, radiological position, waiting time, procedure time and cost. Fifty-eight adult patients with closed, displaced distal radius fractures were included in the study. Pain experienced during manipulation was greatest in patients who received haematoma blocks alone compared with the other two groups. Post-manipulation pain was significantly greater in patients who received a general anaesthetic. Radiological correction was as good in those patients receiving a haematoma block with or without sedation as a general anaesthetic. The waiting and manipulation times and resource costs were greater in those receiving a general anaesthetic. There were no complications related to any of these anaesthetic methods. Patient acceptance is greater with a correctly performed haematoma block and sedation technique compared to general anesthesia. It is also more efficient with regard to time and the resources required. This is particularly important for a progressively increasing ambulatory, elderly population who require prompt, safe, effective and painless management.