超声引导下桡神经和正中神经阻滞与血肿阻滞在桡骨远端骨折复位中的比较研究:随机临床试验。

Q2 Medicine
Medical Journal of the Islamic Republic of Iran Pub Date : 2023-10-23 eCollection Date: 2023-01-01 DOI:10.47176/mjiri.37.113
Saeed Abbasi, Nayyereh Garjani, Babak Mahshidfar, Davood Farsi, Mani Mofidi, Peyman Hafezimoghadam, Mahdi Rezai, Alireza Javan
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引用次数: 0

摘要

背景:桡骨远端骨折是最常见的上肢骨折之一,由于人口老龄化和骨质疏松症的增加,其发病率持续上升。桡骨远端骨折的镇痛方法多种多样,包括血肿阻滞和神经阻滞。血肿阻滞是一种简单有效的镇痛方法,但在某些情况下,其疗效可能有限。另一方面,神经阻滞可提供更有针对性的镇痛,在减轻骨折复位过程中的疼痛方面可能更为有效。本研究旨在比较桡神经和正中神经阻滞与血肿阻滞在超声引导下治疗桡骨远端骨折的镇痛效果。此外,本研究还旨在比较桡神经和正中神经阻滞与血肿阻滞在超声引导下的镇痛效果,以减少桡骨远端骨折的发生:在这项前瞻性试验中,将转诊至两个学术中心的桡骨远端骨折患者随机分为两组,包括血肿阻滞组和桡侧正中神经阻滞组,两组均在超声引导下进行。在阻滞前、阻滞后 5 分钟、10 分钟和 15 分钟、复位开始时、复位过程中以及复位后 5 分钟、10 分钟和 15 分钟,根据视觉模拟量表测量并记录患者的疼痛程度。对患者满意度和医生满意度进行评估,并对副作用进行为期一周的观察。定量变量以平均值 ± 标准差的形式报告,定性变量以数量和频率百分比的形式报告。根据具体情况采用学生 t 检验和卡方检验。显著性水平设定为 P ˂ 0.05:本研究共纳入 120 名患者。两组患者在手术过程中减轻疼痛的效果无明显差异。17名患者在手术过程中需要使用镇痛药物;6名患者使用神经阻滞,11名患者使用血肿阻滞,差异有统计学意义(P = 0.041)。神经阻滞组患者和医生的满意度明显高于血肿阻滞组(P = 0.001;P ˂0.001):本研究结果表明,超声引导下的桡神经和正中神经阻滞可作为急诊科桡骨远端骨折复位术中其他技术的替代镇痛方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial.

Background: Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures.

Methods: In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05.

Results: In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively).

Conclusion: The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

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