Haematoma block versus sedation for manipulating distal radius fractures in the emergency department

Distal radius fractures commonly require manipulation in the emergency department. Procedural sedation is frequently used but is resource-intensive and associated with potential adverse events. Haematoma block may offer a practical alternative, particularly in busy emergency departments, but its comparative efficacy and safety are uncertain.

To evaluate whether haematoma block provides a comparable procedural success rate to procedural sedation, and whether there is a difference in the likelihood of adverse events, in adult patients undergoing manipulation of distal radius fractures in the emergency department.

A structured search of MEDLINE and Embase databases was conducted using the Ovid interface. Studies comparing haematoma block with procedural sedation for manipulation of distal radius fractures in adults were included. Outcomes assessed included procedural success rate and adverse events. Seven studies met inclusion criteria, comprising four randomised controlled trials and three observational studies. Two studies were derived from the same dataset and were combined in the Best Evidence Topic (BET) table as one.

Across the included studies, there was no consistent evidence of a difference in procedural success between haematoma block and procedural sedation. The highest-quality evidence from two randomised controlled trials found no difference in radiographic outcome. Regarding the likelihood of adverse events when comparing haematoma block versus sedation, one study found less pain in the haematoma block group. None of the other studies detected a statistically significant difference.

In adult patients presenting to the emergency department with distal radius fractures requiring manipulation, the use of haematoma blocks appears to be associated with comparable procedural success rate to procedural sedation, without strong evidence of a difference in likelihood of adverse events.