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.
Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block.
To evaluate the effects of clonidine on three local anesthetics (mepivacaine 1%, ropivacaine 0.75% and bupivacaine 0.5%) with comparable potency and almost the same concentration-response relationship.
                One hundred and twenty trauma-patients were randomly allocated into six groups. In the control-groups (Mo/Ro/Bo) brachial plexus was performed using 40 mL of local anesthetic plus 1 mL of NaCL 0.9%. In the clonidine-groups (Mc/Rc/Bc) brachial plexus was performed using each 40 mL of drug plus 1 mL (0.150 mg) of clonidine. Onset-time and the duration of the sensory block were recorded. Data are expressed as mean +/- SD.
                According to the average sensory block determined by a visual analog scale in the median, ulnar and radial nerve distributions and ranging from 100 (no sensory blockade) to 0 (complete sensory blockade), both mepi-groups showed a rapid onset (at 10 min: -Mo 20 +/- 15/Mc 19 +/- 14; at 30 min: -Mo 3 +/- 4/Mc 5 +/- 4). The ropi-and bupi- groups both had a longer onset time (at 10 min: -Ro 23 +/- 19/Rc 25 +/- 22/Bo 24 +/- 15; at 30 min -Ro 10 +/- 6/ Rc 11 +/- 6 /Bo 12 +/- 4). The onset time in group-Bc was significantly prolonged (at 10 min: -45 +/- 21; at 30 min: -20 +/- 6). Duration of motor blockade was prolonged by clonidine only in the mepivacaine and bupivacaine groups; (in minutes: Mo 212 +/- 47 -Mc 468 +/- 62; Ro 702 +/- 52 -Rc 712 +/- 82; Bo 728 +/- 36 -Bc 972 +/- 72).
                The present study shows that the addition of clonidine has a different impact on each of the three local anesthetics investigated in terms of onset and duration of block.