Pain management with ketamine procedural sedation and infraclavicular block for forearm fracture in the emergency department.

BACKGROUND

Forearm fractures frequently present to the Emergency Department (ED). This study compared the results of Procedural Sedation and Analgesia (PSA) with Ketamine and Infraclavicular Block (IB) at 60 min in managing pain during closed reduction of forearm fractures. Side effects, additional analgesic treatments, pre- and post-reduction angles of the fracture, and patient and physician satisfaction were determined.

METHODS

This randomized, controlled, prospective study included 85 patients. PSA (Group P, n = 41) and IB (Group B, n = 44). Pain levels were assessed using the Numerical Rating Scale (NRS) at baseline, 60, and 120 min. Patient and physician satisfaction (5-point Likert scale), rescue analgesic requirements, side effects, length of stay in the ED, and the need for analgesics, especially within 24 h, were recorded.

RESULTS

Both PSA and IB had no superiority over each other in reducing pain at 60 min (p > 0.05). Side effects such as nausea (23.5 %), vomiting (9.4 %), hypotension (7.1 %) and desaturation (11.8 %) were more common in the PSA. Nausea (5.9 %), vomiting (1.2 %) and arrhythmia (1.2 %) were seen in the IB, while hypotension and desaturation were not seen. Rescue analgesia and 24-h analgesic consumption were higher in the PSA group, which also showed longer ED stays (p < 0.05). Patient and physician satisfaction were similar (p > 0.05).

CONCLUSION

Both PSA and IB have similar effects in pain management during the first 60 min of forearm fracture reduction in ED. Patient and physician satisfaction was similar in the two groups. Both methods are preferable applications in the ED for forearm fracture reductions.

CLINICAL TRIALS: NCT06588907.