Comparison of hematoma block and dexmedetomidine for reduction of distal radius fractures in the emergency department: a prospective randomized controlled study

Abstract

BACKGROUND: This study aimed to compare the effects of hematoma block (HB) and dexmedetomidine administration on pain control, reduction quality, and physician satisfaction during the reduction of distal radius fractures (DRFs) in the emergency department (ED). METHODS: A total of 60 patients presenting to the ED with DRFs were enrolled. Patients were randomly assigned to two groups: one received HB, while the other underwent conscious sedation with dexmedetomidine. Pain levels were assessed using the Visual Analog Scale (VAS) at three time points: before the procedure, 10 minutes after administration of the intervention, and post-reduction. Physician satisfaction during reduction was measured using the 5-point Likert Satisfaction Scale (LSS). Post-reduction quality was evaluated on control radiographs using the Sarmiento criteria. RESULTS: Among the patients included in the study, 28 were female, 19 were male, and 13 were children (<12 years). The mean age was 32.97±20.48 years in the dexmedetomidine group (DG) and 35.25±18.92 years in the hematoma block group (HBG), with no statistically significant difference between the groups (t=-0.448, p=0.65). There was no significant difference in physician satisfaction during reduction between the two groups according to LSS results (χ²=2.296, p=0.512). Pre-procedure VAS scores were comparable between the two groups (t=-0.148, p=0.883). However, VAS scores 10 minutes after the intervention were significantly lower in the DG compared to the HBG (p=0.009, t=-2.773). Post-reduction quality based on the Sarmiento criteria showed no significant difference between the groups (χ²=0.64, p=0.89). No adverse effects related to either method were observed in any of the patients. CONCLUSION: Dexmedetomidine provides faster and more effective pain management than HB for DRF reduction in the ED. Given its minimal systemic side effects, dexmedetomidine may represent a viable alternative for procedural sedation and analgesia (PSA) in fracture reductions requiring sedation in the ED.