Analgesia for the reduction of Colles fracture. A comparison of hematoma block and intravenous sedation.

Abstract

OBJECTIVE:

An alternative to general anesthesia was tested against conventional sedation by a double-blind, randomized clinical trial in reduction of Colles fracture.

SETTINGS:

A large teaching hospital where cases of Colles fracture are not different from those seen in district hospitals.

PATIENTS:

Sixty-six out of 80 consecutive cases with this fracture were selected from March to August 1990 on the basis of: 1) informed consent; 2) no contraindication to any method of analgesia; 3) no analgesic during the past 8 hours; 4) injury duration less than 96 hours; 5) no mental, auditory, or visual impairment; and 6) no associated injury.

INTERVENTIONS:

Patients were randomized into 2 equal groups. After tests for Xylocaine (Astra brand of lidocaine hydrochloride) sensitivity in both groups, the A group received 30 mg of pentazocine with 5 mg of diazepam intravenously on the dorsum of the affected wrist (sedation group), whereas the B group received 20 cc of 1.5% Xylocaine into the fracture hematoma. Five minutes later the fracture was reduced and immobilized by Lakhtakia or A. Singh.

MAIN OUTCOME MEASURES:

Thirteen to 15 hours later Manglik, blinded to the analgesia status of the patient, recorded pain before, during, and after reduction using Visual Analogue Scale (VAS).

MAIN RESULTS:

Statistically, randomization and blinding were found to be effective. The pain scores during reduction in the local anesthetic group (median = 1.8) were significantly less than those in the sedation group (median = 8.7), P < 0.001 using the Wilcoxon rank sum test. The difference persisted in regression analysis. The 2 methods proved comparable in safety and other measures of effectiveness.

CONCLUSIONS:

Hematoma block by local anesthetic is a safe and effective alternative to sedation in reduction of Colles fracture.

• Authors: G K Singh, R K Manglik, P K Lakhtakia, A Singh
• Journal: The Online journal of current clinical trials (Online J Curr Clin Trials) Vol. Doc No 23 Pg. [3614 words; 43 paragraphs] (Oct 01 1992) ISSN: 1059-2725 [Print] United States
• PMID: 1343612 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Lidocaine
• Diazepam
• Pentazocine

Topics

• Adult
• Analgesia (methods)
• Anesthesia, Intravenous
• Anesthesia, Local
• Colles' Fracture (surgery)
• Diazepam (administration & dosage)
• Double-Blind Method
• Female
• Fracture Fixation
• Hematoma
• Humans
• Lidocaine (administration & dosage)
• Male
• Pain (prevention & control)
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Pentazocine (administration & dosage)