The American journal of emergency medicine · 2025
US-guided axillary nerve block vs. fracture hematoma block for forearm fracture analgesia in the ED: A randomised controlled trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Rook B, Bosch van den E, Haak S L, Have van der E, Edwards C M, Lameijer H
Аннотация
AIM: Fracture hematoma blocks (FHB) are commonly used for analgesia in distal forearm fracture reduction. However, the effectiveness is suboptimal due to variability in technique among physicians and fracture type and the procedure is often perceived as painful by patients. This study investigated whether an ultrasound-guided axillary nerve block (ANB) is an effective alternative for analgesia during reduction of displaced distal forearm fractures in patients in the emergency department (ED).
METHOD: In this randomised controlled trial, we compared pain scores on the numeric rating scale (NRS) during closed distal forearm fracture reduction with either an ANB or a FHB. Additionally, we evaluated differences in satisfaction scores of patients and physicians and the total procedural time. Post-hoc we evaluated differences in acceptable pain levels (NRS0-4) and unacceptable pain levels (NRS 5-10).
RESULTS: A total of 57 patients were randomised to the ANB group and 58 to the FHB group. The ANB procedure itself was less painful compared to a FHB (p < 0.001). There was no statistical difference of 2.0 points in absolute pain scores on the NRS scale during fracture reduction (FHB 6.0 (IQR 4.0-8.0) vs. ANB 4.0 (IQR 2.0-8.0, p = 0.120)). More patients in the ANB group reported a clinically acceptable pain level (NRS 0-4) during reduction (p = 0.048). The reported satisfaction scores among patients and physicians did not differ between both groups.
CONCLUSION: We did not demonstrate statistical superiority of the ANB compared to the FHB in fracture reduction analgesia. While the ANB procedure was less painful, patient satisfaction was the same and ANB appeared to be more time-consuming. Using ANB for the reduction of distal forearm fractures in the ED can be an alternative to FHB, particularly if there are sufficient resources, such as ED personnel and time.
METHOD: In this randomised controlled trial, we compared pain scores on the numeric rating scale (NRS) during closed distal forearm fracture reduction with either an ANB or a FHB. Additionally, we evaluated differences in satisfaction scores of patients and physicians and the total procedural time. Post-hoc we evaluated differences in acceptable pain levels (NRS0-4) and unacceptable pain levels (NRS 5-10).
RESULTS: A total of 57 patients were randomised to the ANB group and 58 to the FHB group. The ANB procedure itself was less painful compared to a FHB (p < 0.001). There was no statistical difference of 2.0 points in absolute pain scores on the NRS scale during fracture reduction (FHB 6.0 (IQR 4.0-8.0) vs. ANB 4.0 (IQR 2.0-8.0, p = 0.120)). More patients in the ANB group reported a clinically acceptable pain level (NRS 0-4) during reduction (p = 0.048). The reported satisfaction scores among patients and physicians did not differ between both groups.
CONCLUSION: We did not demonstrate statistical superiority of the ANB compared to the FHB in fracture reduction analgesia. While the ANB procedure was less painful, patient satisfaction was the same and ANB appeared to be more time-consuming. Using ANB for the reduction of distal forearm fractures in the ED can be an alternative to FHB, particularly if there are sufficient resources, such as ED personnel and time.