Comparing the effects of haematoma block and conscious sedation in adults with distal radius fractures

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BACKGROUND: Distal radius fractures present frequently to the orthopaedic surgeon following high velocity injuries in the young or low velocity injuries in the elderly. Haematoma block or conscious sedation can be applied to provide anaesthesia during reduction. Comparing the effects of both anaesthetic methods is yet to be fully evaluated. OBJECTIVE: To compare the pain level and quality of reduction using haematoma block and conscious sedation following reduction of distal radius fractures. DESIGN: Prospective comparative cross-sectional study. PATIENTS AND METHODS: Seventy patients with distal radius fractures were grouped for closed reduction; in one group conscious sedation was used and the other, haematoma block. All patients had pain measured with Visual Analogue Scale and quality of reduction by measuring palmar tilt on plain radiograph. MAIN OUTCOME MEASURES: Severity of pain and palmar tilt on radiograph measured before and after reduction. RESULTS: The modal age group was 60 years (40%) with a slightly higher female preponderance (57.1%). Majority, 54.3% had injuries following fall on outstretched hand. The mean Visual Analogue Score for pain following conscious sedation and haematoma block post reduction was 3.5 and 2.4 respectively. The mean palmar tilt of radius for conscious sedation and haematoma groups were 10.1 and 10.9 degrees respectively. There was no statistically significant difference in the efficacy of both anaesthetic methods. CONCLUSION: The choice anaesthesia for reduction of distal radius fracture on should be based on surgeon’s preference, patient’s wish and history of drug reactions.

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