Comparison of the Effect of Hematoma Block and Injection of Lidocaine with and without Ketamine on Reduction of Pain in Patients with Distal Radius Fracture

Document Type : Original Article (s)

10.22122/jims.v39i613.13635

Abstract

Background: Hematoma block (HB) is a technique for local anesthesia injection between fractured bone fragments. The aim of the present study was to compare the effect of HB with injection of lidocaine with and without ketamine on reduction of pain, blood pressure, and heart rate in patients with distal radius fracture.
Methods: In this randomized double-blind clinical trial study, a total of 60 patients with distal radius fracture were randomly selected and divided in two equal groups. Patients in the first group underwent HB with injection of 8 ml lidocaine 2%, and patients in group B underwent HB with injection of 8 ml lidocaine 2% plus ketamine (0.5 mg/kg). The intensity of pain, blood pressure, and heart rate were measured before, during, and after 1 and 6 hours of bone placement.
Findings: There was no significant difference in the mean pain between the two groups before bone reduction (P = 0.87). But, the mean pain significantly was lower in group B during (P = 0.004) and 1 (P < 0.001) and 6 (P < 0.001) hours after bone reduction.
Conclusion: According to our data, it can be concluded that combination of ketamine and lidocaine has better analgesic effect in HB technique in patients with distal radius fracture. However, further studies should be conducted to confirm our data.

Keywords


Shauver MJ, Yin H, Banerjee M, Chung KC. Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg Am 2011; 36(8): 1282-7.
Levin LS, Rozell JC, Pulos N. Distal radius fractures in the elderly. J Am Acad Orthop Surg 2017; 25(3): 179-87.
Thelen S, Grassmann JP, Jungbluth P, Windolf J. Distal radius fractures: Current treatment concepts and controversies. Chirurg 2018; 89(10): 798-812. [In German].
Porrino JA, Maloney E, Scherer K, Mulcahy H, Ha AS, Allan C. Fracture of the distal radius: Epidemiology and premanagement radiographic characterization. AJR Am J Roentgenol 2014; 203(3): 551-9.
McCarty EC, Mencio GA, Walker LA, Green NE. Ketamine sedation for the reduction of children's fractures in the emergency department. J Bone Joint Surg Am 2000; 82-A(7): 912-8.
Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol 2017; 30(4): 507-12.
Kazemeini A, Rahimi M, Fazeli MS, Mirjafari SA, Ghaderi H, Fani K, et al. The effect of local injections of bupivacaine plus ketamine, bupivacaine alone, and placebo on reducing postoperative anal fistula pain: A randomized clinical trial. ScientificWorldJournal 2014; 2014: 424152.
Jha AK, Bhardwaj N, Yaddanapudi S, Sharma RK, Mahajan JK. A randomized study of surgical site infiltration with bupivacaine or ketamine for pain relief in children following cleft palate repair. Paediatr Anaesth 2013; 23(5): 401-6.
Tverskoy M, Oren M, Vaskovich M, Dashkovsky I, Kissin I. Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism: A study in postoperative patients. Neurosci Lett 1996; 215(1): 5-8.
Siddiqui AS, Raees US, Siddiqui SZ, Raza SA. Efficacy of pre-incisional peritonsillar infiltration of ketamine for post-tonsillectomy analgesia in children. J Coll Physicians Surg Pak 2013; 23(8): 533-7.
Tabrizi A, Mirza TF, Hassani E, Taleb H, Elmi A. Hematoma block versus general anesthesia in distal radius fractures in patients over 60 years in trauma emergency. Anesth Pain Med 2017; 7(1): e40619.
Orbach H, Rozen N, Rinat B, Rubin G. Hematoma block for distal radius fractures - prospective, randomized comparison of two different volumes of lidocaine. J Int Med Res 2018; 46(11): 4535-8.
Ogunlade SO, Omololu AB, Alonge TO, Salawu SA, Bamgboye EA. Haematoma block in reduction of distal radial fractures. West Afr J Med 2002; 21(4): 282-5.
Kvarnstrom A, Karlsten R, Quiding H, Gordh T. The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury. Acta Anaesthesiol Scand 2004; 48(4): 498-506.
Kvarnstrom A, Karlsten R, Quiding H, Emanuelsson BM, Gordh T. The effectiveness of intravenous ketamine and lidocaine on peripheral neuropathic pain. Acta Anaesthesiol Scand 2003; 47(7): 868-77.