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Three Part Question

In [elderly patients with uncomplicated Colles fractures] is [haematoma block with bupivicaine better than lignocane] for [reducing pain during reduction and providing longer term post manipulation analgesia].

Clinical Scenario

A 67 year old female attends the Emergency department after a fall onto outstretched hand. X-rays identify a Colles fracture with dorsal angulation and shortening of the distal radius which requires manipulation. With experience of reducing Colles fractures you wonder if bupivacaine will give better analgesia improving patient comfort during and after the procedure than lignocaine.

Search Strategy

MEDLINE, EMBASE, CINAHL, COCHRANE, WEB OF SCIENCE AND NATIONAL RESEARCH REGISTER were searched via the world wide web using the NHS Evidence Health Information Rersources.
[(exp COLLES FRACTURES OR "colle* fracture*".af) AND (exp LIDOCAINE OR lignocaine.af OR lidocaine.af) AND (exp BUPIVACAINE OR bupivacaine.af) AND (exp PRILOCAINE OR prilocaine.af) AND (exp *ANAESTHESIA, LOCAL/OR exp *ANAESTHETICS, LOCAL/ OR "local anaesthe*".af OR "local anesthe*".af) AND ("haematoma block.af" OR "hematoma block.af" OR exp *HEMATOMA/) AND (exp NERVE BLOCK/) AND (*RADIUS FRACTURE/)]

Search Outcome

96 papers were found.
The only relevant study paper was not finished.

Comment(s)

The haematoma block is currently more commonly used than the Biers block (intravenous regional anaesthesia) to manipulate Colles fractures in the Emergency Department. No studies have yet been identified that compares the use and efficacy of different types of local anaesthetic agents in haematoma blocks for uncomplicated Colles fractures.

Clinical Bottom Line

With no clinical evidence available the choice of local anaesthetic agent used in haematoma block depends on; local trust policies, the types of available local anaesthetic agents and clinician experience in both using local anaesthetic and reducing Colles fractures.