Distal radius kırıklarının redüksiyonu öncesi analjezi yöntemi olarak hematom bloğu ve sedoanaljezi yöntemlerinin karşılaştırılması

Yıl 2021, Cilt: 46 Sayı: 3, 1100 - 1107, 30.09.2021

Melih Bağır , Akif Mirioğlu , Mustafa Tekin , Ömer Biçer , Cenk Özkan

https://doi.org/10.17826/cumj.910800

Cited By: 1

Öz

Amaç: Bu çalışmanın amacı deplase distal radius kırıklarının redüksiyonu sırasında, analjezi amaçlı kullanılan hematom bloğu ve sedoanaljezi tekniklerinin redüksiyon kalitesi, hastanede kalış süresi ve ağrı kontrolü açısından retrospektif olarak karşılaştırılmasıdır.
Gereç ve Yöntem: İzole deplase distal radius kırığı tanısı ile kapalı redüksiyon uygulanan 106 hasta değerlendirildi. Hastaların 45’ine hematom bloğu, 61’ine sedoanaljezi uygulandı. Sedoanaljezik olarak midazolam (0,1mg/kg) ve fentanyl (1 mcg/kg), lokal anestezik olarak da lidokain (10 ml %1) kullanıldı. Demografik veriler, Frykman sınıflamasına göre kırık tipleri ve travma mekanizmaları değerlendirildi. Hastaların ağrı değerlendirmesi Vizüel analog skala (VAS) ile yapıldı. Redüksiyon kalitesi Sarmiento kriterlerine göre değerlendirildi. Analjezi yöntemlerinin maliyet değerlendirilmesi prosedürlerin ücretleri, kullanılan ilaçlar ve medikal malzemeler üzerinden yapıldı.
Bulgular: Her iki grup cinsiyet, yaş, kırık tipi ve etkilenen taraf açısından benzerdi. Hematom bloğu grubunda hastanede kalış süresi daha kısa idi ve VAS skoru belirgin olarak daha düşüktü. Redüksiyon kalitesi her iki grupta benzerdi. Hasta başı maliyet, sedoanaljezi grubunda hematom bloğu ile karşılaştırıldığında dört kat fazla idi.
Sonuç: Hematom bloğu, distal radius kırıklarının redüksiyonu öncesi ağrıyı azaltmak için kullanılan kolay ve etkili bir yöntemdir. Özellikle sedoanaljezi yönteminin yan etkilerine daha hassas olan yaşlı hastalarda, analjezi sağlamak için daha güvenli bir yöntem olan hematom bloğu tercih edilebilir.

Anahtar Kelimeler

radius kırığı, hematom bloğu, sedoanaljezi

Comparison of hematoma block and sedoanalgesia for analgesia before reduction of distal radius fractures

Öz

Purpose: The aim of this study was retrospective assessment of the reduction quality, hospitalization time, and relief of pain in hematoma block assisted closed reduction versus sedoanalgesia assisted closed reduction.
Materials and Methods: There were 106 patients included who diagnosed as isolated displaced distal fracture of radius and treated with closed reduction. Hematoma block was used in 45 patients and sedoanalgesia was used in 61 patients. Midazolam (0,1 mg/kg) and fentanyl (1 mcg/kg) combination was administered as the sedoanalgesic agent, and lidocaine (10 ml, 1%) as the local anaestetic. Demographic data, fracture type according to Frykman classification, and mechanism of trauma were noted. Pain status of patients were recorded by using the Visual analog scale (VAS). Sarmiento criteria was used for the evaluation of the reduction quality. Cost of the analgesic procedure was assessed based on the prices of the analgesia procedures, used pharmaceuticals and medical consumables.
Results: Both groups were similar in terms of gender, age, fracture type and affected side., Hospitalization time was shorter in hematoma block group, and VAS was significantly lower. Quality of reduction was similar in both groups. Cost per patient was four times higher in sedoanalgesia group compare to hematoma block group.
Conclusion: Hematoma block is an effective, easily performed method that can be used prior to the closed reduction of the distal radius fractures to relieve the pain. Older patients can be susceptible to adverse effects of sedoanalgesia and hematoma block can be chosen as a more reliable method to provide the analgesia.

Anahtar Kelimeler

radius fracture, hematoma block, sedoanalgesia

Kaynakça

• 1. Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018 Apr;49(2):211-222.
• 2. Gamba C, Fernandez FAM, Llavall MC, Diez XL, Perez FS. Which immobilization is better for distal radius fracture? A prospective randomized trial. Int Orthop. 2017 Sep;41(9):1723-1727.
• 3. Bear DM, Friel NA, Lupo CL, Pitetti R, Ward WT. Hematoma block versus sedation for the reduction of distal radius fractures in children. J Hand Surg Am 2015;40(1):57-61.
• 4. Turgut A, Erkuş S, Koca A, Payzıner L, Çiçek AO, Kalenderer Ö. Analysis of the factors causing tight cast syndrome after closed reduction and casting of pediatric distal radius fractures. Acta Orthop Traumatol Turc. 2018;52(5):329-333.
• 5. Tseng PT, Leu TH, Chen YW, Chen YP. Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture? J Orthop Surg Res. 2018 Mar 27;13(1):62.
• 6. Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS, Watters WC 3rd, Goldberg MJ, Keith M, Turkelson CM, Wies JL, Haralson RH 3rd, Boyer KM, Hitchcock K, Raymond L. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010 Mar;18(3):180-9.
• 7. Zengin EC, Ozcan C, Aslan C, Bulut T, Sener M. Cast immobilization versus volar locking plate fixation of AO type C distal radial fractures in patients aged 60 years and older. Acta Orthop Traumatol Turc. 2019 Jan;53(1):15-18.
• 8. Handoll HH, Madhok R, Dodds C. Anaesthesia for treating distal radial fracture in adults. Cochrane Database Syst Rev. 2002;(3):CD003320.
• 9. Maleitzke T, Plachel F, Fleckenstein FN, Wichlas F, Tsitsilonis S. Haematoma block: a safe method for pre-surgical reduction of distal radius fractures. J Orthop Surg Res. 2020 Aug 26;15(1):351
• 10. Funk L. A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius. Injury. 1997; 28: 209-12.
• 11. Koren L, Ginesin E, Elias S, Wollstein R, Israelit S. The Radiographic Quality of Distal Radius Fracture Reduction Using Sedation Versus Hematoma Block. Plast Surg (Oakv). 2018 May;26(2):99-103.
• 12. Myderrizi N, Mema B. The hematoma block an effective alternative for fracture reduction in distal radius fractures. Med Arh. 2011;65(4):239-42.
• 13. Frykman G. Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand. 1967: Suppl 108:3+.
• 14. Sarmiento A., Pratt G.A.W., Berry N.C., Sinclair W.F. Colles’ fractures: functional bracing in supination. J Bone Jt Surg. 1975;57A:311–317.
• 15. 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.
• 16. Fathi M, Moezzi M, Abbasi S, Farsi D, Zare MA, Hafezimoghadam P. Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial. Emerg Med J. 2015;32(6):474–7.
• 17. Singh GK, Manglik RK, Lakhtakia PK, Singh A. Analgesia for the reduction of Colles fracture. A comparison of hematoma block and intravenous sedation. Online J Curr Clin Trials. 1992 Oct 1; Doc No 23:[3614 words; 43 paragraphs].
• 18. Handoll HH, Madhok R. Closed reduction methods for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;(1):CD003763.
• 19. Furia JP, Alioto RJ, Marquardt JD. The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures. Orthopedics. 1997 May;20(5):423-6.
• 20. Tabrizi A, Mirza Tolouei F, 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. 2016 Nov 27;7(1):e40619.
• 21. Fernandez DL. Closed manipulation and casting of distal radius fractures. Hand Clin. 2005 Aug;21(3):307-16.
• 22. Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015 Mar;48(3):310-2.
• 23. Dorf E, Kuntz AF, Kelsey J, Holstege CP. Lidocaine-induced altered mental status and seizure after hematoma block. The Journal of emergency medicine. 2006;31(3):251–253.