• Marzieh Fathi, Meysam Moezzi, Saeed Abbasi, Davood Farsi, Mohammad Amin Zare, and Peyman Hafezimoghadam.
• Rasoul Akram Hospital, Iran University of Medical Sciences, Niyayesh St, Sattarkhan Ave, Tehran, Iran.
• Emerg Med J. 2015 Jun 1; 32 (6): 474-7.

ObjectiveWe compared the efficacy and safety of ultrasound-guided haematoma block with that of procedural sedation and analgesia in patients with acute distal radial fracture reduction pain control.MethodsThis was a randomised clinical trial on adult patients conducted in two teaching hospitals. Patients received intravenous midazolam plus fentanyl in the procedural sedation and analgesia group, and fracture site injection of lidocaine 10% in the ultrasound guided haematoma block group. We measured pain scores before reduction, during reduction and 5, 10 and 15 min after reduction by a numeric rating scale, and patient and physician satisfaction by a four-level Likert scale. Time to discharge, early adverse effects and late complications were also compared.ResultsWe enrolled 160 patients with distal radial fracture and randomised 143 patients into two groups (after excluding 17 patients). Pain was effectively controlled in both groups. Pain scores had no statistically significant difference before and during reduction and 5 and 15 min after reduction in the procedural sedation and analgesia and ultrasound guided haematoma block groups. Patient and physician overall satisfaction were similar in the two groups. Time to discharge was significantly lower in the ultrasound guided haematoma block group. Four patients (5.5%) in the procedural sedation and analgesia group showed early adverse effects. No patient in either group showed any late complications.ConclusionsUltrasound guided haematoma block may be a safe and effective alternative to procedural sedation and analgesia.Trial Registration Number201112308104N5.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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