Hematoma Block for Wrist Fractures

(Hematoma Block Trial)

Overseen By Beatrice Hoffmann, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Beth Israel Deaconess Medical Center

Disqualifiers: High distress, Intoxication, Dementia, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 day

115 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this study is to determine the efficacy of ultrasound guided hematoma block versus traditional "blind" hematoma block for analgesia in distal radius fracture reduction.

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.

What data supports the effectiveness of the treatment Ultrasound Guided Hematoma Block for wrist fractures?

Research shows that ultrasound-guided hematoma blocks are effective for pain control and fracture reduction in forearm and sternal fractures, suggesting they may also be effective for wrist fractures. This method is considered faster and as effective as sedation, with rare complications. ^{1 2 3 4 5}

Is a hematoma block for wrist fractures safe?

Hematoma blocks are generally considered safe and effective for pain relief in wrist fractures, but rare complications can occur, such as short-term neurological symptoms due to the absorption of the anesthetic. ^{1 2 3 4 5}

How is the ultrasound-guided hematoma block treatment for wrist fractures different from other treatments?

The ultrasound-guided hematoma block is unique because it uses ultrasound to precisely guide the injection of local anesthesia directly into the fracture site, providing effective pain relief without the need for sedation or general anesthesia, which is typically required for fracture reduction. ^{2 3 4 5 6}

Research Team

Beatrice Hoffmann, MD

Principal Investigator

Beth Israel Deaconess Medical Center

Eligibility Criteria

This trial is for adults over 18 who come to the emergency department with a distal radius fracture, which is a type of broken bone near the wrist. It's not specified who can't join, but typically those with additional health complications might be excluded.

Inclusion Criteria

I am over 18 and went to the ER for a wrist fracture.

Exclusion Criteria

High acuity/distress per the Attending ED physician

Altered mental status or intoxication

Aphasia, mental retardation, dementia, or insurmountable communication barrier

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

Treatment

Participants receive either a traditional or ultrasound-guided hematoma block for analgesia in distal radius fracture reduction

1 day

1 visit (in-person)

Follow-up

Participants are monitored for pain reduction and safety after the procedure

4 hours

Treatment Details

Interventions

• Ultrasound Guided Hematoma Block

Trial Overview The study aims to compare two methods of pain relief during bone setting: one using an ultrasound guide (a device that helps visualize inside the body) and the traditional method without visual aid.

Participant Groups

Group I: ultrasound-guided hematoma block Experimental Treatment 1 Intervention

Patients in this arm will receive a bed-side ultrasound guided hematoma block with analgesia (0.25% bupivacaine)

Group II: traditional hematoma block Active Control 1 Intervention

Patients in this arm will have the hematoma block of the distal radius fracture with no ultrasound for guidance with analgesia (0.25% bupivacaine)

Who Is Running the Clinical Trial?

Beth Israel Deaconess Medical Center

Lead Sponsor

Trials

872

Recruited

12,930,000+

Harvard University

Collaborator

Trials

237

Recruited

588,000+

Findings from Research

An ultrasound-guided hematoma block was successfully used in the Emergency Department to provide immediate pain relief for a patient with a sternal fracture, demonstrating its effectiveness in acute pain management.

This technique may enhance safety and efficiency in pain control, potentially leading to quicker discharge times from the hospital or Emergency Department for selected patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pain control for sternal fracture using an ultrasound-guided hematoma block. Wilson, SR., Price, DD., Penner, E.[2016]

In a study of 110 patients with distal radius fractures, both the cubital nerve block (CNB) and axillary nerve block (ANB) provided significantly better pain relief during various stages of treatment compared to the conventional fracture hematoma block (FHB).

The ANB was particularly effective, resulting in lower pain scores during the block procedure, fracture reduction, and after plaster cast application, even though the physicians performing the blocks had minimal prior experience with ultrasound guidance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Nerve Blocks as Analgesia for Nonoperative Management of Distal Radius Fractures-Two Consecutive Randomized Controlled Trials. Siebelt, M., Hartholt, KA., van Winden, DFM., et al.[2020]

A pediatric patient with a distal radius fracture successfully underwent a hematoma block guided by ultrasound, allowing for fracture reduction without the need for sedation.

This case suggests that ultrasound-guided hematoma blocks could be a safe and effective alternative to procedural sedation for treating fractures in children, although further research is needed to establish broader efficacy in pediatric populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Point-of-Care Ultrasound-Guided Hematoma Block for Forearm Fracture Reduction. Singh, A., Khalil, P.[2023]

Ultrasound-guided hematoma blocks provide better visualization and potentially improved analgesia for patients with distal radius fractures, especially in complicated cases.

This technique is particularly beneficial for fractures that are difficult to localize using traditional landmark methods, including those with concomitant ulnar styloid fractures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided hematoma block for distal radial and ulnar fractures. Gottlieb, M., Cosby, K.[2022]

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]

A case report highlights that an elderly patient experienced a generalized tonic-clonic seizure after receiving a hematoma block with lidocaine and bupivacaine for a distal radius fracture, despite the doses being within recommended limits.

The incident suggests that using a combination of anesthetics in hematoma blocks may increase the risk of neurological complications in elderly patients, indicating the need for precautions and immediate treatment options during such procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Distal Radius Fracture Hematoma Block with Combined Lidocaine and Bupivacaine can induce Seizures while within Therapeutic Window: A Case Report. Dezfuli, B., Edwards, CJ., DeSilva, GL.[2020]

References

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

Pain control for sternal fracture using an ultrasound-guided hematoma block. [2016]

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

Ultrasound-Guided Nerve Blocks as Analgesia for Nonoperative Management of Distal Radius Fractures-Two Consecutive Randomized Controlled Trials. [2020]

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

Point-of-Care Ultrasound-Guided Hematoma Block for Forearm Fracture Reduction. [2023]

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

Ultrasound-guided hematoma block for distal radial and ulnar fractures. [2022]

5. 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]

6. India pubmed.ncbi.nlm.nih.gov

Distal Radius Fracture Hematoma Block with Combined Lidocaine and Bupivacaine can induce Seizures while within Therapeutic Window: A Case Report. [2020]