Periosteal block versus intravenous regional anesthesia for reduction of distal radius fractures: A randomized controlled trial

Objective We compare periosteal block and intravenous regional anesthesia (IVRA) as anesthetic techniques for reduction of distal radius fractures when performed by emergency department (ED) clinicians following brief training. Methods This was a single-center, nonblinded randomized controlled trial of a convenience sample of patients presenting with distal radius fractures requiring closed reduction. Primary outcome measure was patient reported fracture reduction pain score, rated on a 100-mm visual analog scale. Secondary outcomes included adjunct pain medication use, ED length of stay, remanipulation rates, participant satisfaction, clinician assessed efficacy, and clinician-assessed ease of the procedure. Results Eighty-one patients were randomized to receive IVRA (n = 41) or periosteal block (N = 40). Reduction pain scores were not normally distributed. Median (25th-75th percentile) pain scores in participants assigned to IVRA and periosteal block were 5 (1-27.5) and 26 (8.5-63) mm, respectively, (p = 0.007). Use of adjunct medications during reduction was higher for the periosteal block group compared with IVRA (57.5% vs. 22.5%, p = 0.003). Remanipulation rates were 17.5% for periosteal block versus 7.5% for IVRA (p = 0.31). There was no difference in length of stay, patient satisfaction, or clinician's assessed ease of the anesthetic technique. There was a difference in clinician's assessment of efficacy between groups, with IVRA described as "extremely effective" by 65% and periosteal block described as "extremely effective" by 25% (p = 0.003). Conclusions When performed by a diverse group of ED clinicians periosteal block provided inferior analgesia to IVRA but may provide an alternative when IVRA cannot be performed.