Effect of Hematoma Block Combined with Intravenous Diazepam versus Hematoma Block in Closed Colles’ Fracture

Main Article Content

Arun Woranuch, MD
Thanakorn Pinyo, MD
Thananit Sangkomkamhang, MD

Abstract

Introduction: There are many different anesthesia options to reduce pain in reduction of Colles’fracture. The most convenient anesthesia option is a hematoma block but this procedure is not a good anesthesia because patients still experience moderate pain during reduction. From current observational studies show that hematoma block added through intravenous sedation can reduce pain in patients.


Objective: To compare the effectiveness of the hematoma block with intravenous (IV) diazepam versus hematoma block alone in relieving pain of the closed reduction of Colles’ fracture in adult patients.


Materials and Methods: Closed Colles’ fracture patients who visited emergency department, Khon Kaen hospital during December 2016-December 2017 and were performed close reduction were enrolled to the study and were randomly assigned to hematoma block combined with intravenous diazepam group and hematoma block group. Visual analog scale (VAS) before and during the procedure were evaluated in both groups. The primary outcome was the mean difference of visual analog scale.


Results: A total of 22 patients were enrolled in the study, 11 patients received hematoma block with IV diazepam and 11 received hematoma block alone. The average VAS scale during reduction was 3.09 for the hematoma block with IV diazepam group and 2.82 for the hematoma block alone group, with a mean difference of 0.27(-1.25-0.71) (p=0.28). No complications were experienced in both trial groups.


Conclusion: The effectiveness of hematoma block alone is not difference to hematoma block with IV diazepam to reduce pain during closed reduction in closed Colles’ fracture.

Article Details

Section
Original Articles

References

1. Court-Brown CM, Heckman JD, McKee M, McQueen MM, Ricci W. Rockwood and Green's fractures in adults. 8th ed. Philadelphia, PA: Wolters Kluwer Health; 2014. p.1075-138.
2. Handoll HH, Madhok R, Dodds C. Anaesthesia for treating distal radial fracture in adults. Cochrane Database Syst Rev. 2002; (3): 1-14.
3. Kendall JM, Allen P, Younge P, Meek SM, McCabe SE. Hematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?. J Accid Emerg Med. 1997; 14(6): 352-6
4. Wardrope J, Flowers M, Wilson DH. Comparison of local anaesthetic techniques in the reduction of Colles' fracture. Arch Emerg Med. 1985; 2(2): 67-72.
5. Cobb AG, Houghton GR. Local anaesthetic infiltration versus Bier's block for Colles' fractures. Br Med J (Clin Res Ed). 1985; 291(6510): 1683-4
6. Myderrizi N, Mema B. The hematoma block an effective alternative for fracture reduction in distal radius fractures. Med Arh. 2011; 65(4): 239-42.
7. Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009; 139(2): 267-84.
8. Ronald D. Miller. Miller's Anesthesia. Eighth Edition. San Francisco: Elsevier; 2014. 821-63.
9. ราชวิทยาลัยวิสัญญีแพทย์. Practice guidelines for conscious sedation. กรุงเทพ 2553. Available from http://www.anesthai.org/public/rcat/Documents/document/1459488165-CPG-5_2555_guidesed-concious-Sedation.pdf
10. Funk L. A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius. Injury. 1997; 28(3): 209-12.
11. Singh GK, Manglik RK, Lakhtakia PK, Singh A. Analgesia for the reduction of Colles fracture. A comparison of hematoma block and intravenous sedation. Online J Curr Clin Trials. 1992; 23.
12. Bernard R. Fundamentals of biostatics. 5th ed. Duxbery: Thomson learning; 2000. P.307.
13. Wadsworth TG. Colles' fracture. BMJ. 1990; 301(6745): 192-4.
14. Man KH, Fan KP, Chan TN, Yue YM, Sin FP, Lam KW. A prospective clinical trial comparing self-administered nitrous oxide and haematoma block for analgesia in reducing fracture of the distal radius in an emergency department. Hong Kong J Emerg Med. 2010; 17(2): 126-31.
15. DiPiro JT, Schwinghammer T, Wells B. Pharmacotherapy Handbook. 8th ed. USA: McGraw Hill Professional; 2014. p.743-46.
16. Lexicomp. Diazepam, Drug information, 2016. Available from: http:// www.uptodate.com/contents/diazepam-drug-information?source=search_result&search=diazepam&selectedTitle=1~150
17. Cloyd JC, Lalonde RL, Beniak TE, Novack GD. A single-blind, crossover comparison of the pharmacokinetics and cognitive effects of a new diazepam rectal gel with intravenous diazepam. Epilepsia. 1998; 39(5): 520-6.
18. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al, Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013, 41(1): 263-306.
19. Earnshaw SA, Aladin A, Surendran S, Moran CG. Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study. J Bone Joint Surg Am. 2002; 84(3): 354-8.
20. Greller H, Gupta A. Benzodiazepine poisoning and withdrawal. 2016. Available from: http:// www.uptodate.com/contents/benzodiazepine-poisoning-and-withdrawal?topicKey=EM%2F314&elapsedTimeMs=0&source=search_result&searchTerm=diazepam&selectedTitle=10~150&view=print&displayedView=full#
21. Browning RD, Allen GD, Kinney EB, Carranza FA Jr. A comparison of oral and intravenous diazepam sedation for periodontal surgery. Anesth Prog. 1987; 34(2): 46-50.