Periosteal Nerve Block Vs. Intravenous Morphine in Pain Relief of Distal Radius and Ulna Fracture; a Double-Blind Randomized Clinical Trial
学术急诊医学档案,
卷 11 编号 1 (2023),
15 十一月 2022
,
第 e51 页
https://doi.org/10.22037/aaem.v11i1.2056
摘要
Introduction: Distal forearm fractures’ realignment and fixation is a painful procedure. This study aimed to compare the efficacy of periosteal nerve block and intravenous morphine in distal radius and ulna fractures’ pain management.
Methods: In the present randomized, parallel, double-blind, controlled clinical trial, patients with distal radius or ulna fractures were divided into two groups. In the first group, for periosteal nerve block, 1% lidocaine was injected at a distance of 6 to 8 cm near the wrist from the lateral radius and medial ulna. In the second group, morphine sulfate at a dose of 0.1 mg/kg was slowly injected through the peripheral vein within 5 minutes. The visual analog scale (VAS) score was evaluated before the intervention and every 15 minutes until 90 minutes after the intervention and was compared between the two groups.
Results: 75 subjects were studied (39 in the periosteal nerve block and 36 in the intravenous morphine group). There were no significant differences between the groups in terms of mean age (p = 0.384), gender distribution (p = 0.464), past medical history (p = 0.106), trauma type (p = 0.836), fracture type (p = 0.613), and baseline pain severity on VAS (p = 0.987). Both methods reduced the VAS scores during the 90 minutes of the study. The mean pain scores of the patients in the periosteal nerve block group with 2.56±1.44, 2.15±1.11, 2.66±1.26, and 3±1.27 at 15, 30, 45, and 60 minutes after the analgesic injection, respectively, were significantly lower than those of the intravenous morphine group with 4.75±1.27, 4.22±1.22, 3.97±1.27, and 4.13±1.35, respectively (p < 0.001 for all comparisons). In the present study, no local or systemic complications were observed in the periosteal nerve block group, while the complications of dyspnea, vomiting, and pruritus were reported by 5.5%, 2.8%, and 2.8%, respectively, in the intravenous morphine group. Moreover, the percentage of need for additional analgesia in the intravenous morphine group was higher than that of the periosteal nerve block group.
Conclusion: In the first hour after the intervention, pain reduction in periosteal block was significantly higher than intravenous morphine administration. Also, the incidence of complications and the need for additional analgesia were lower in the periosteal block group compared to intravenous morphine administration.
- Clinical Trial
- Periosteal Nerve
##submission.howToCite##
参考
Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908-15.
O’neill TW, Cooper C, Finn JD, Lunt M, Purdie D, Reid DM, Rowe R, Woolf AD, Wallace WA, UK Colles’ Fracture Study Group. Incidence of distal forearm fracture in British men and women. Osteoporos Int. 2001;12:555-8.
Azizkhani R, Hassan S, Boroumand A, Rastin G, Ghasemi A, Shahbazi A. Analgesic Effects of Ketamine Nebulizer vs. Intravenous Morphine in Limb Trauma Patients in Pre-Hospital Emergency Setting; A Randomized Double-Blinded Clinical Trial. Advanced journal of emergency medicine. 2020;4(4):e84.
S Sankar B, Ng AB. Circumferential periosteal block in the reduction of distal radius fractures. Ann R Coll Surg Engl. 2005;87(2):141.
El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local and regional anesthesia. 2018;11:35-44.
Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain management in the emergency department: a review article on options and methods. Advanced journal of emergency medicine. 2018;2(4):e45.
Handoll HH, Madhok R, Dodds C. Anaesthesia for treating distal radial fracture in adults. Cochrane Database Syst Rev. 2002(3):Cd003320.
Mohammadshahi A, Abdolrazaghnejad A, Nikzamir H, Safaie A. Intranasal ketamine administration for narcotic dose decrement in patients suffering from acute limb trauma in emergency department: a double-blind randomized placebo-controlled trial. Advanced journal of emergency medicine. 2018;2(3):e30.
Janati M, Kariman H, Memary E, Davarinezhad-Moghadam E, Arhami-Dolatabadi A. Educational intervention effect on pain management quality in emergency department; a clinical audit. Advanced journal of emergency medicine. 2018;2(2):e16.
Tageldin ME, Alrashid M, Khoriati AA, Gadikoppula S, Atkinson HD. Periosteal nerve blocks for distal radius and ulna fracture manipulation--the technique and early results. J Orthop Surg Res. 2015;10:134.
Frenkel O, Herring AA, Fischer J, Carnell J, Nagdev A. Supracondylar radial nerve block for treatment of distal radius fractures in the emergency department. J Emerg Med. 2011;41(4):386-8.
Constantine E, Steele DW, Eberson C, Boutis K, Amanullah S, Linakis JG. The use of local anesthetic techniques for closed forearm fracture reduction in children: a survey of academic pediatric emergency departments. Pediatr Emerg Care. 2007;23(4):209-11.
Abbaszadegan H, Jonsson U. Regional anesthesia preferable for Colles' fracture: controlled comparison with local anesthesia. Acta Orthop Scand. 1990 Jan 1;61(4):348-9.
Cobb AG, Houghton GR. Local anaesthetic infiltration versus Bier's block for Colles' fractures. BMJ (Clinical research ed.). 1985;291(6510):1683.
Wardrope J, Flowers M, Wilson DH. Comparison of local anaesthetic techniques in the reduction of Colles' fracture. Emerg Med J. 1985;2(2):67-72.
Ali WA, Soh EZ, Abdullah S, Singh PS, Ahmad AA, Sapuan J. Pain perception during the phases of manual reduction of distal end radius fracture with a periosteal block. Cureus. 2021;13(1).
Ahmad AA, Ikram MA. Plating of an isolated fracture of shaft of ulna under local anaesthesia and periosteal nerve block. Trauma Case Rep. 2017;12:40-4.
SShaik NA, Rao SS, Chiruvella S, Rao MS, Reddy SV. Effectiveness of butorphanol as an adjuvant to lidocaine for haematoma or periosteal block: A prospective, randomised, double blind study. Indian J Anaesth. 2013;57(2):150.
- 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 703 ##plugins.themes.ojsPlusA.frontend.article.times##
- pdf (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 654 ##plugins.themes.ojsPlusA.frontend.article.times##
##plugins.themes.ojsPlusA.frontend.article.downloadstatastics##
##plugins.block.makeSubmission.linkLabel##
SJR
COPE
