Does the addition of peripheral nerve blocks improve analgesia during distal radius fracture reduction? A prospective, randomized, multicenter clinical trial.

PURPOSE: This study aimed to evaluate whether adding a median nerve and a superficial branch of the radial nerve block to hematoma block improves analgesia during distal radius fracture reduction and to identify factors associated with increased pain perception.

METHODS

A prospective, randomized, controlled study was conducted in two tertiary hospitals, including 180 adult patients with displaced distal radius fractures requiring closed reduction. Patients were allocated either to an isolated hematoma block group or to a combined block group receiving hematoma block with median nerve and superficial branch of the radial nerve blocks. Within the combined group, half of the median nerve blocks were performed under ultrasound guidance and half using anatomical landmarks. The primary endpoint was digital pain during traction and fracture reduction, assessed using a visual analog scale (VAS, 0-10). Secondary outcomes included wrist pain at different procedural stages and the influence of demographic and clinical variables including age, sex, laterality, participating hospital, body mass index (BMI), fracture type (AO/OTA), and baseline psychiatric or chronic analgesic medication use.

RESULTS

Digital pain was significantly lower in combined group compared with isolated hematoma block during traction (4.54 ± 2.53 vs. 7.39 ± 1.76; p < 0.001) and reduction (5.36 ± 2.56 vs. 8.33 ± 1.55; p < 0.001). No differences were observed in wrist pain at any stage. Female sex, psychiatric or chronic analgesic medication use, and BMI ≥ 30 were independently associated with higher pain scores. No differences were found between ultrasound-guided and landmark-based median nerve blocks (p = 0.74). Fracture type did not influence pain outcomes. Two cases of transient neuropathic pain occurred in the landmark-based subgroup, resolving without sequelae.

CONCLUSIONS

The combination of hematoma block with median nerve and superficial branch of the radial nerve block was associated with lower digital pain during distal radius fracture reduction compared with isolated hematoma block, without increasing complications. Female sex, obesity, and baseline psychiatric or chronic analgesic medication use were associated with higher pain perception in exploratory analyses. RETROSPECTIVELY REGISTERED CLINICAL TRIAL (18TH SEPTEMBER 2025): ClinicalTrials.gov, NCT07183904.