1887
Volume 2024, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Distal radius fractures are the most frequent upper extremity fractures in the whole population. The incidence of distal radius fractures is 195.2/100,000, and the rate is increasing. It can occur with low-energy trauma in the elderly associated with osteoporosis. The purpose of this study is to compare the two different treatment groups (1. Sedation analgesia, 2. Supracondylar radial nerve block) in terms of reduction in Visual Analogue Scale (VAS) score, the length of hospital stay, complications, side effects, patient-physician satisfaction, and the ease of application.

Patients diagnosed with distal radius fracture were enrolled prospectively, to whom the study’s exclusion criteria do not apply. The patients included in the study were randomly separated into two groups. Ketofol was administered to the sedation and analgesia group’s patients at a dose of 0.5 mg/kg (ketamine 0.5 mg/kg, propofol 0.5 mg/kg) intravenously, and supracondylar radial nerve block was performed on the other group’s patients under ultrasound guidance.

There were 20 patients (6 male, 14 female) in the sedation and analgesia group and 21 patients (11 male, 10 female) in the supracondylar radial nerve block group. There was no significant difference between the groups regarding patient-physician satisfaction and complications. The length of hospital stay was significantly shorter in the supracondylar radial nerve block group (49.25 ± 4.05) compared with the sedation and analgesia group (125 ± 5.85) (p < 0.01). The mean reduction VAS score in the block group was observed to be lower than the admission VAS score (p < 0.01).

Consequently, ultrasound-guided supracondylar radial nerve block would be a valuable alternative to procedural sedation analgesia and could become routine clinical practice in treating distal radius fractures.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2024.10
2024-02-29
2024-07-20
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2024/3/jemtac.2024.10.html?itemId=/content/journals/10.5339/jemtac.2024.10&mimeType=html&fmt=ahah

References

  1. De Lorenzo RA, Mayer D, Geehr EC. Analyzing clinical case distributions to improve an emergency medicine clerkship. Ann Emerg Med. 1990 Jul; 19:(7):746-51. doi: 10.1016/s0196-0644(05)81697-x.
    [Google Scholar]
  2. National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary Tables [Internet]. CDC; [cited 2014 Apr 27]. Available from: https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2008_ed_web_tables.pdf
    [Google Scholar]
  3. Karagas MR, Baron JA, Barrett JA, Jacobsen SJ. Patterns of fracture among the United States elderly: geographic and fluoride effects. Ann Epidemiol. 1996 May; 6:(3):209-16. doi: 10.1016/1047-2797(96)00006-3.
    [Google Scholar]
  4. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006 Aug; 37:(8):691-7. doi: 10.1016/j.injury.2006.04.130.
    [Google Scholar]
  5. Koval K, Haidukewych GJ, Service B, Zirgibel BJ. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014 Sep; 22:(9):566-75. doi: 10.5435/JAAOS-22-09-566.
    [Google Scholar]
  6. Lewis LM, Lasater LC, Brooks CB. Are emergency physicians too stingy with analgesics? South Med J. 1994 Jan; 87:(1):7-9. doi: 10.1097/00007611-199401000-00002.
    [Google Scholar]
  7. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989 Nov; 7:(6):620-3. doi: 10.1016/0735-6757(89)90286-6.
    [Google Scholar]
  8. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007 Jul; 105:(1):205-21. doi: 10.1213/01.ane.0000268145.52345.55.
    [Google Scholar]
  9. Robinson KS., Jagim MM., and Ray CE., (2005) Nursing workforce issues and trends affecting emergency departments. Nurs Manage. 36:(9): p. 46-53.
    [Google Scholar]
  10. Padegimas EM, Ilyas AM. Distal radius fractures: emergency department evaluation and management. Orthop Clin North Am. 2015 Apr; 46:(2):259-70. doi: 10.1016/j.ocl.2014.11.010.
    [Google Scholar]
  11. Camu F, Vanlersberghe C. Pharmacology of systemic analgesics. Best Pract Res Clin Anaesthesiol. 2002 Dec; 16:(4):475-88. doi: 10.1053/bean.2002.0262.
    [Google Scholar]
  12. Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005 Sep-Oct; 26:(5):553-7. doi: 10.1007/s00246-004-0707-4.
    [Google Scholar]
  13. Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011 May; 57:(5):425-33.e2. doi: 10.1016/j.annemergmed.2010.08.032.
    [Google Scholar]
  14. Thomas MC, Jennett-Reznek AM, Patanwala AE. Combination of ketamine and propofol versus either agent alone for procedural sedation in the emergency department. Am J Health Syst Pharm. 2011 Dec 1; 68:(23):2248-2256. doi: 10.2146/ajhp110136.
    [Google Scholar]
  15. David H, Shipp J. A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation. Ann Emerg Med. 2011 May; 57:(5):435-41. doi: 10.1016/j.annemergmed.2010.11.025.
    [Google Scholar]
  16. Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012 Jun; 59:(6):504-12.e1-2. doi: 10.1016/j.annemergmed.2012.01.017.
    [Google Scholar]
  17. Miner JR, Moore JC, Austad EJ, Plummer D, Hubbard L, Gray RO. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015 May; 65:(5):479-488.e2. doi: 10.1016/j.annemergmed.2014.08.046.
    [Google Scholar]
  18. Willman EV, Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007 Jan; 49:(1):23-30. doi: 10.1016/j.annemergmed.2006.08.002.
    [Google Scholar]
  19. Tezel O, Kaldirim U, Bilgic S, Deniz S, Eyi YE, Ozyurek S, et al. A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction. Am J Emerg Med. 2014 Jun; 32:(6):549-52. doi: 10.1016/j.ajem.2014.02.014.
    [Google Scholar]
  20. Erden IA, Pamuk AG, Akinci SB, Koseoglu A, Aypar U. Comparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures. Minerva Anestesiol. 2010 Apr; 76:(4):260-5.
    [Google Scholar]
  21. Myderrizi N, Mema B. The hematoma block an effective alternative for fracture reduction in distal radius fractures. Med Arh. 2011; 65:(4):239-42. doi: 10.5455/medarh.2011.65.239-242.
    [Google Scholar]
  22. Funk L. A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius. Injury. 1997 Apr; 28:(3):209-12. doi: 10.1016/s0020-1383(96)00183-0.
    [Google Scholar]
  23. Isfahani MN, Javid M. Ultrasound-guided supracondylar radial nerve block to manage distal radius fractures in the emergency department, Journal of Emergency Medicine, Trauma & Acute Care 2020:14. doi:10.5339/jemtac.2020.14.
    [Google Scholar]
/content/journals/10.5339/jemtac.2024.10
Loading
/content/journals/10.5339/jemtac.2024.10
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): distal radius fractureKetamine-Propofolprocedural sedation and radial nerve block
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error