Hematoma Block as an Adjunct to Procedural Sedation for Forearm Fracture Reduction

The purpose of our study is to determine if the use of a hematoma block together with intravenous sedation and analgesia is an effective means of managing forearm fractures in the Emergency Department. To determine this, we have designed a randomized, double-blind, placebo controlled trial of hematoma block versus saline for the manipulation of forearm fractures under conscious sedation with ketamine and midazolam. Our hypotheses are two-fold: First, the use of a hematoma block together with conscious sedation will allow for improved pain control. Second, the use of a hematoma block together with conscious sedation will allow us to use less sedation, therefore promoting faster recovery from sedation and more efficient patient turnover in the Emergency Department.

Hematoma block, Lidocaine, Forearm fracture, Radius fracture, Ulna fracture, Ketamine, Midazolam, Procedural sedation

Subjects randomly assigned to this arm will receive 2% lidocaine by injection into their fracture site in the form of a hematoma block.

Subjects randomly assigned to this arm will receive normal saline by injection into their fracture site

2% Lidocaine (no epinephrine) in the dose of 2.5 mg/kg to a maximum of 10mL will be instilled once into the fracture site in the form of a hematoma block.

Inclusion Criteria: English or Spanish speaking Ages 3-17 Closed distal forearm fracture requiring reduction under sedation in the Emergency Department Fracture involves the distal third of the forearm Exclusion Criteria: Multiple trauma victims Associated nerve or vascular damage Associated elbow or humerus injury Sensitivity or allergy to lidocaine Contraindications to procedural sedation Previous attempts at reduction for the same injury