Hematoma Block for Distal Radius Fracture

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine the efficacy of ultrasound guided hematoma block versus traditional blind hematoma block for analgesia in distal radius fracture reduction.

Detailed Description
-----------------
Hematoma blocks are safe and effective in providing analgesia for fracture reduction1-4. They involve injecting lidocaine directly into the fracture line for analgesia. The physician aspirates blood prior to injection to confirm placement in the hematoma created by the fracture. However, the procedure can be technically difficult if the fracture line is difficult to palpate, for example, due to significant swelling or body habitus. Ultrasound has been shown to improve efficacy in other analgesic procedures such as peripheral nerve blocks5 and also in identifying fracture lines6. There have been case reports and case series which have shown the feasibility and effectiveness of ultrasound guided hematoma blocks for analgesia in patients undergoing reduction for distal radius fractures7,8. To our knowledge there are no randomized controlled trials comparing the use of ultrasound guided hematoma blocks versus traditional hematoma blocks in achieving analgesia for distal radius fracture reduction. In this study, we will determine if ultrasound improves the efficacy of analgesia when performing hematoma blocks for reduction of distal radius fractures.

Official Title
-----------------
Comparison of Ultrasound-guided Hematoma Block and Blind Hematoma Block for Analgesia in Distal Radius Fractures

Conditions
-----------------
Distal Radius Fracture

Intervention / Treatment
-----------------
* Other: ultrasound guide


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult patient ≥ 18 years old presenting to the emergency department with complaint of distal radius fracture Exclusion Criteria: High acuity/distress per the Attending ED physician Altered mental status or intoxication Aphasia, mental retardation, dementia, or insurmountable communication barrier Acute psychiatric illness

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ultrasound-guided hematoma block<br>Patients in this arm will receive a bed-side ultrasound guided hematoma block with analgesia (0.25% bupivacaine) | Other: ultrasound guide<br>* Patients randomized to this arm will have the hematoma block of the distal radial fracture with the guidance of a bedside ultrasound<br>|
| No Intervention: traditional hematoma block<br>Patients in this arm will have the hematoma block of the distal radius fracture with no ultrasound for guidance with analgesia (0.25% bupivacaine) | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Reduction as indicated by Visual Analog Scale | Subjects will be surveyed on a Visual Analog Scale (VAS) on their pain during 4 points: prior to receiving hematoma block, after receiving hematoma block, during reduction and prior to discharge | 4 hours after initiation of study procedure | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Hematoma block, distal radius fracture reduction, ultrasound, ultrasound guided hematoma block, traditional hematoma block for analgesia, bupivacaine, pain reduction, wrist fracture