Peripheral nerve blocks for closed reduction of distal radius fractures-A systematic review with meta-analysis and trial sequential analysis

被引：2

作者：

Pisljagic, Sanja ^{[1
]}

Temberg, Jens L. ^{[1
]}

Steensbaek, Mathias T. ^{[1
]}

Yousef, Sina ^{[1
]}

Maagaard, Mathias ^{[2
]}

Chafranska, Lana ^{[1
]}

Lange, Kai H. W. ^{[1
,3
]}

Rothe, Christian ^{[1
]}

Lundstrom, Lars H. ^{[1
,3
]}

Norskov, Anders K. ^{[1
,3
]}

机构：

[1] Copenhagen Univ Hosp North Zealand, Dept Anaesthesiol, Dyrehavevej 29, DK-3400 Hillerod, Denmark

[2] Zealand Univ Hosp, Ctr Anaesthesiol Res, Dept Anaesthesiol, Koge, Denmark

[3] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark

来源：

ACTA ANAESTHESIOLOGICA SCANDINAVICA | 2024年 / 68卷 / 09期

关键词：

closed reduction; distal radius fracture; regional anaesthesia; RECOVERY SCORE; POSTOPERATIVE QUALITY; SHAM SURGERY; EPIDEMIOLOGY;

D O I：

10.1111/aas.14474

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults. Methods: We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction. Results: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau(2 )= 5.4, I-2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau(2) = 0.9, I-2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low. Conclusion: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.

引用

页码：1149 / 1160

页数：12

共 50 条

[1]

aaos, Management of distal radius fractures: evidence-based clinical practice guideline

[2]

Alimohammadi H, 2013, EMERGENCY, V1, P11

[3]

Alimohammadi Hossein, 2014, Acta Med Iran, V52, P122

[4]

Aniel-Quiroga M, 2023, Rev Esp Cir Ortop Traumatol, V67, P371, DOI 10.1016/j.recot.2023.03.004

[5]

[Anonymous], 1996, Guideline for Good Clinical Practice E6 (R1)

[6]

[Anonymous], Veritas Health Innovation

[7]

Bajracharya S., 2007, Int J Anaesthesiol, V17

[8]

Balduzzi S., How to perform a metaanalysis with R: a practical tutorial. Evidencebased mental health

[9] Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area [J].

Bergh, Camilla ;

Wennergren, David ;

Moller, Michael ;

Brisby, Helena .

PLOS ONE, 2020, 15 (12)

[10]

Bram R., Ultrasound guided axillary nerve block compared to hematoma block in patients with closed reposition of distal forearm fractures

← 1 2 3 4 5 →