Hematoma vs Bier Block for Broken Bones

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: University of Utah

Disqualifiers: Pregnant, Lactating, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 1 day

500 Participants Needed

Trial Summary

What is the purpose of this trial?

The investigators objective of this study is to evaluate the effectiveness of hematoma block versus intravenous regional anesthesia (Bier block) during closed reduction of distal radius fractures.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

Is the Bier block or hematoma block with lidocaine safe for treating broken bones?

The Bier block, using low-dose lidocaine, is generally safe for treating upper extremity fractures in both children and adults, with no significant complications reported. Hematoma blocks are also considered safe, but there is a rare risk of short-term neurological symptoms due to lidocaine absorption. ^{1 2 3 4 5}

How does the Bier Anesthetic Block Procedure differ from other treatments for broken bones?

The Bier Anesthetic Block Procedure is unique because it uses a low-dose lidocaine administered intravenously to provide regional anesthesia, allowing for safe and effective outpatient treatment of fractures with minimal pain and quick recovery of full neurological function. This contrasts with the Hematoma Block, which involves injecting lidocaine directly into the fracture site and may carry a risk of systemic absorption and neurological symptoms. ^{1 2 5 6 7}

Research Team

Lucas Marchand, MD

Principal Investigator

University of Utah Orthopaedics

Eligibility Criteria

This trial is for adults over 18 with a closed distal radius fracture needing reduction, who have normal sensation and pulse in the affected arm. Excluded are those unable to consent, non-English speakers, incarcerated individuals, pregnant or lactating women, patients with skin issues at the fracture site or open fractures.

Inclusion Criteria

My wrist bone is out of place and needs to be corrected.

I can feel and move my hands normally, and my wrist pulse is good.

I need a procedure to fix a bone fracture without surgery.

Exclusion Criteria

I am unable to give informed consent due to being intubated or having cognitive impairments.

Pregnant or lactating women

I do not have skin issues or infections over my fracture.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either a hematoma block or a Bier block for closed reduction of distal radius fractures

1 day

1 visit (in-person)

Follow-up

Participants are monitored for pain and reduction quality after the procedure

4 weeks

1 visit (in-person)

Treatment Details

Interventions

• Bier Anesthetic Block Procedure with 1% Lidocaine
• Hematoma Local Anesthetic Block Procedure with 1% Lidocaine

Trial Overview The study compares two types of anesthesia during wrist fracture repair: Hematoma Block using local anesthetic directly at the injury site and Bier Block which involves anesthetizing the entire arm by injecting into a vein.

Participant Groups

Group I: Hematoma Block Experimental Treatment 1 Intervention

Inject 20 mL of 1% lidocaine without epinephrine into the hematoma site.

Group II: Bier Block Experimental Treatment 1 Intervention

Intravenous administration a maximum lidocaine dose of 3 mg/kg.

Who Is Running the Clinical Trial?

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

Findings from Research

Hematoma blocks are generally a safe and effective method for providing anesthesia during the treatment of displaced distal radius fractures, allowing for closed reduction.

However, there is a rare risk of systemic neurologic complications from local anesthetics, as demonstrated in a case where a patient experienced such complications after receiving a hematoma block with 20 mL of 1% lidocaine.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Hematoma Block in the Wrist for a Displaced Distal Radius Fracture Induces Systemic Neurological Symptoms: A Case Report. Burch, CS., Stevens, CG.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

A Hematoma Block in the Wrist for a Displaced Distal Radius Fracture Induces Systemic Neurological Symptoms: A Case Report. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Mini-dose Bier block intravenous regional anesthesia in the emergency department treatment of pediatric upper-extremity injuries. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Intravenous regional anesthesia: a safe and cost-effective outpatient anesthetic for upper extremity fracture treatment in children. [2013]

4. England pubmed.ncbi.nlm.nih.gov

Hematoma block for distal radius fractures - prospective, randomized comparison of two different volumes of lidocaine. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Safe and effective IV regional anesthesia for use in the emergency department. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Safe and effective IV regional anesthesia for use in the emergency department. [2022]

7. England pubmed.ncbi.nlm.nih.gov

The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E. [2019]