PMID- 29580286
OWN - NLM
STAT- MEDLINE
DCOM- 20180904
LR  - 20220408
IS  - 1749-799X (Electronic)
IS  - 1749-799X (Linking)
VI  - 13
IP  - 1
DP  - 2018 Mar 27
TI  - Hematoma block or procedural sedation and analgesia, which is the most effective 
      method of anesthesia in reduction of displaced distal radius fracture?
PG  - 62
LID - 10.1186/s13018-018-0772-7 [doi]
LID - 62
AB  - BACKGROUND: Procedure sedation and analgesia (PSA) is often used to alleviate 
      discomfort and to facilitate fracture reduction for patients with distal radius 
      fracture in emergency departments and clinics, but risks of respiratory distress 
      and needs for different levels of monitoring under PSA are still under concern. 
      Hematoma block (HB) is a simple alternative method of providing rapid pain relief 
      during reduction of distal radius fracture. However, there is still in lack of 
      strong evidence to promote HB over PSA in clinical practice. The aim of this 
      study was to compare HB and PSA for adult and pediatric patients during reduction 
      of displaced distal radius fracture to identify the level of pain relief, 
      frequency of adverse effects (AEs), and reduction failure. METHODS: The PubMed, 
      ScienceDirect, Cochrane Library, and ClinicalTrials.gov were searched for studies 
      comparing HB or PSA in distal radius fracture reduction. The search revealed four 
      randomized controlled trials and one non-randomized trial, which included two 
      studies of pediatric subjects and three studies of adult subjects. Subgroup 
      meta-analysis for adult and pediatric groups were specifically performed 
      according to age difference to avoid potential bias. RESULTS: In the adult group, 
      the effect of HB on post-reduction pain severity was better than that of PSA with 
      significant heterogeneity (Hedges' g - 0.600, 95% confidence interval (CI) 
      - 1.170 to - 0.029, p = 0.039), although there was no difference on the pain 
      severity during reduction between these two groups with significant heterogeneity 
      (Hedges' g 0.356, 95% CI - 1.101 to 1.812, p = 0.632). In the pediatric group, 
      the treatment effect on pain severity was significantly better by HB than that by 
      PSA but without significant heterogeneity (Hedges' g - 0.402, 95% CI - 0.718 to 
      - 0.085, p = 0.013, I (2)  < 0.001%). Most of the reported adverse effects (AEs) 
      include nausea, vomiting, and respiratory distress developed in adult patients 
      treated by PSA. The rates of reported AEs did not significantly differ between HB 
      and PSA in the pediatric group. Additionally, final outcomes of reduction failure 
      did not significantly differ between HB and PSA in both adult and pediatric 
      groups. CONCLUSION: Hematoma block is a safe and effective alternative of 
      anesthesia in reduction of distal radius fracture without inferior pain relief 
      compared with PSA among adult and pediatric patients.
FAU - Tseng, Ping-Tao
AU  - Tseng PT
AD  - WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan.
FAU - Leu, Tsai-Hsueh
AU  - Leu TH
AD  - Department of Orthopaedic Surgery, Wan Fang Hospital, School of Medicine, College 
      of Medicine, Taipei Medical University, Number 111, Section 3, Xinglong Road, 
      Wenshan District, Taipei City, 116, Taiwan.
FAU - Chen, Yen-Wen
AU  - Chen YW
AD  - Prospect clinic for otorhinolaryngology & neurology, Kaohsiung City, Taiwan.
FAU - Chen, Yu-Pin
AU  - Chen YP
AD  - Department of Orthopaedic Surgery, Wan Fang Hospital, School of Medicine, College 
      of Medicine, Taipei Medical University, Number 111, Section 3, Xinglong Road, 
      Wenshan District, Taipei City, 116, Taiwan. yupin99231@gmail.com.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20180327
PL  - England
TA  - J Orthop Surg Res
JT  - Journal of orthopaedic surgery and research
JID - 101265112
RN  - 0 (Anesthetics, Local)
SB  - IM
MH  - Analgesia/*methods
MH  - Anesthetics, Local/*administration & dosage
MH  - Conscious Sedation/*methods
MH  - Fracture Fixation/*methods
MH  - Hematoma
MH  - Humans
MH  - Pain Measurement/methods
MH  - Pain, Postoperative/prevention & control
MH  - Radius Fractures/*surgery
PMC - PMC5869786
OTO - NOTNLM
OT  - Hematoma block
OT  - Procedural sedation and analgesia
OT  - Radius fracture
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Not applicable CONSENT FOR 
      PUBLICATION: Not applicable COMPETING INTERESTS: The authors declare that they 
      have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral 
      with regard to jurisdictional claims in published maps and institutional 
      affiliations.
EDAT- 2018/03/28 06:00
MHDA- 2018/09/05 06:00
PMCR- 2018/03/27
CRDT- 2018/03/28 06:00
PHST- 2017/09/03 00:00 [received]
PHST- 2018/03/12 00:00 [accepted]
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/09/05 06:00 [medline]
PHST- 2018/03/27 00:00 [pmc-release]
AID - 10.1186/s13018-018-0772-7 [pii]
AID - 772 [pii]
AID - 10.1186/s13018-018-0772-7 [doi]
PST - epublish
SO  - J Orthop Surg Res. 2018 Mar 27;13(1):62. doi: 10.1186/s13018-018-0772-7.