BACKGROUND: Forearm fractures frequently present to the Emergency Department (ED). This study compared the results of Procedural Sedation and Analgesia (PSA) with Ketamine and Infraclavicular Block (IB) at 60 min in managing pain during closed reduction of forearm fractures. Side effects, additional analgesic treatments, pre- and post-reduction angles of the fracture, and patient and physician satisfaction were determined.
METHODS: This randomized, controlled, prospective study included 85 patients. PSA (Group P, n = 41) and IB (Group B, n = 44). Pain levels were assessed using the Numerical Rating Scale (NRS) at baseline, 60, and 120 min. Patient and physician satisfaction (5-point Likert scale), rescue analgesic requirements, side effects, length of stay in the ED, and the need for analgesics, especially within 24 h, were recorded.
RESULTS: Both PSA and IB had no superiority over each other in reducing pain at 60 min (p > 0.05). Side effects such as nausea (23.5 %), vomiting (9.4 %), hypotension (7.1 %) and desaturation (11.8 %) were more common in the PSA. Nausea (5.9 %), vomiting (1.2 %) and arrhythmia (1.2 %) were seen in the IB, while hypotension and desaturation were not seen. Rescue analgesia and 24-h analgesic consumption were higher in the PSA group, which also showed longer ED stays (p < 0.05). Patient and physician satisfaction were similar (p > 0.05).
CONCLUSION: Both PSA and IB have similar effects in pain management during the first 60 min of forearm fracture reduction in ED. Patient and physician satisfaction was similar in the two groups. Both methods are preferable applications in the ED for forearm fracture reductions.
CLINICAL TRIALS: NCT06588907.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Very low impact study. Practitioners will continue to use the approach that is most familiar to them.
Physician rater
This study showed no difference in the outcome and similar effectiveness of both techniques.
Physician rater
The primary aim of this study was to demonstrate the success and ease of fracture reduction by decreasing pain in patients with distal forearm fractures. However, the sample size was calculated solely based on pain reduction outcomes. Therefore, this small study does not provide sufficient evidence to conclude that the success rate and ease of reduction are comparable between the two techniques.
, McMaster University