Regional anaesthesia vs haematoma block in the management of distal radius fractures: Introduction of a regional anaesthesia list.

Abstract

A regional anaesthesia list was introduced in an outpatient clinic for the manipulation of distal radius fractures. Outcomes in patients managed with regional anaesthesia were compared with those managed using a haematoma block. Data was collected prospectively on 66 patients with displaced distal radius fractures manipulated using a haematoma block. Following introduction of the regional anaesthesia list, data was collected on 55 patients prospectively. Radiological parameters were recorded pre and post manipulation. Patient's pain was measured following anaesthesia and following reduction. Surgical intervention rates were recorded for fractures that lost reduction in the weeks following manipulation. PROMs were measured at 18-month follow-up using the PRWE and EQ5D-3 L. Post reduction volar tilt was superior in the regional group (2.4 degrees) compared to the haematoma group (0.5 degrees). Surgical intervention was required in 22 patients in the haematoma group due to loss of reduction, compared to six in the regional anaesthesia group. Pain levels were reported to be lower in patients managed using regional anaesthesia. At 18-month follow-up PROMs were comparable in both groups. The paper supports the use of regional anaesthesia to manipulate distal radius fractures. Regional anaesthesia provides better pain relief, achieves better fracture reduction and reduces the need for surgical intervention. IV.