Hematoma Block as an Adjunct to Procedural Sedation for Forearm Fracture Reduction

Hematoma Blocks in Forearm Fractures: An Effective Adjunct to Procedural Sedation?

The purpose of our study is to determine if the use of a hematoma block together with intravenous sedation and analgesia is an effective means of managing forearm fractures in the Emergency Department. To determine this, we have designed a randomized, double-blind, placebo controlled trial of hematoma block versus saline for the manipulation of forearm fractures under conscious sedation with ketamine and midazolam. Our hypotheses are two-fold: First, the use of a hematoma block together with conscious sedation will allow for improved pain control. Second, the use of a hematoma block together with conscious sedation will allow us to use less sedation, therefore promoting faster recovery from sedation and more efficient patient turnover in the Emergency Department.

Inclusion Criteria:

• English or Spanish speaking
• Ages 3-17
• Closed distal forearm fracture requiring reduction under sedation in the Emergency Department
• Fracture involves the distal third of the forearm

Exclusion Criteria:

• Multiple trauma victims
• Associated nerve or vascular damage
• Associated elbow or humerus injury
• Sensitivity or allergy to lidocaine
• Contraindications to procedural sedation
• Previous attempts at reduction for the same injury