Ultrasound-guided peripheral nerve blocks versus hematoma block for closed reduction of distal radius fractures in adults: A meta-analysis.

Abstract

Fracture reduction is painful and requires effective analgesia. Ultrasound (US)-guided peripheral nerve blocks are increasingly used but may be limited by equipment, expertise, and time. Hematoma block is a simpler, low-cost alternative, although its comparative efficacy and safety remain uncertain. This study aimed to compare the efficacy and clinical outcomes of ultrasound-guided peripheral nerve blocks versus hematoma block in adults undergoing closed reduction of distal radius fractures. This meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials and observational studies comparing US-guided peripheral nerve blocks with hematoma block in adults undergoing distal radius fracture reduction. Pain outcomes and clinical endpoints were pooled using random-effects models and expressed as standardized mean differences (SMD), mean differences (MD), or risk ratios (RR) with 95% confidence intervals (CI). Four studies (538 patients; 261 nerve block, 277 hematoma block) were included. Nerve blocks reduced pain after analgesia (SMD -0.57; 95% CI -0.96 to -0.18) and during block performance (SMD -0.53; 95% CI -1.04 to -0.02). Pain during reduction was similar between groups (SMD -0.13; 95% CI -0.41 to 0.15). Successful reduction was higher with nerve blocks (RR 1.47; 95% CI 1.19-1.82), with no differences in emergency department length of stay (MD 5.73 min; 95% CI -8.46 to 19.92) or need for surgery (RR 0.59; 95% CI 0.29-1.17). US-guided peripheral nerve blocks were associated with improved post-intervention analgesia and higher reduction success compared with hematoma block, without differences in pain during reduction, emergency department length of stay, or need for surgery.