Efficacy of a Modified Bier's Block in Patients Undergoing Upper Limb Bone Surgery

Jafarian, Ali; Hassani, Valiollah; Jamshidi, Fatemeh; Ramezani, Koosha; Javaheri, Fereydoun; Shariatzadeh, Hooman

doi:10.5812/aapm.22007

Cited by 8 publications

(9 citation statements)

References 11 publications

(32 reference statements)

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“…In addition to HB and PSA, several methods of anesthesia have also been advocated for alleviating discomfort and facilitating reduction in patients with displaced distal radius fracture, including intravenous regional anesthesia (Bier block) and regional nerve blocks [ 9 , 29 , 30 ]. Intravenous regional anesthesia (Bier block) has proven effective for anesthesia during upper limb surgery [ 31 , 32 ]. However, concerns still exist over the complications including pain at the tourniquet site, local anesthetic toxicity, and instant recurrence of pain at surgical site following tourniquet deflation and the serious dangers of leakage of anesthetic after accidental deflation of the tourniquet [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Tseng¹,

Leu

Chen³

et al. 2018

J Orthop Surg Res

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BackgroundProcedure sedation and analgesia (PSA) is often used to alleviate discomfort and to facilitate fracture reduction for patients with distal radius fracture in emergency departments and clinics, but risks of respiratory distress and needs for different levels of monitoring under PSA are still under concern. Hematoma block (HB) is a simple alternative method of providing rapid pain relief during reduction of distal radius fracture. However, there is still in lack of strong evidence to promote HB over PSA in clinical practice. The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure.MethodsThe PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials.gov were searched for studies comparing HB or PSA in distal radius fracture reduction. The search revealed four randomized controlled trials and one non-randomized trial, which included two studies of pediatric subjects and three studies of adult subjects. Subgroup meta-analysis for adult and pediatric groups were specifically performed according to age difference to avoid potential bias.ResultsIn the adult group, the effect of HB on post-reduction pain severity was better than that of PSA with significant heterogeneity (Hedges’ g − 0.600, 95% confidence interval (CI) − 1.170 to − 0.029, p = 0.039), although there was no difference on the pain severity during reduction between these two groups with significant heterogeneity (Hedges’ g 0.356, 95% CI − 1.101 to 1.812, p = 0.632). In the pediatric group, the treatment effect on pain severity was significantly better by HB than that by PSA but without significant heterogeneity (Hedges’ g − 0.402, 95% CI − 0.718 to − 0.085, p = 0.013, I2 < 0.001%). Most of the reported adverse effects (AEs) include nausea, vomiting, and respiratory distress developed in adult patients treated by PSA. The rates of reported AEs did not significantly differ between HB and PSA in the pediatric group. Additionally, final outcomes of reduction failure did not significantly differ between HB and PSA in both adult and pediatric groups.ConclusionHematoma block is a safe and effective alternative of anesthesia in reduction of distal radius fracture without inferior pain relief compared with PSA among adult and pediatric patients.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0772-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Tseng¹,

Leu

Chen³

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

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“…Intravenous regional anesthesia (IVRA) is a simple type of regional anesthesia that has many advantages such as: reliability, effectiveness, economic for day care, and safe for emergency surgery when patient is full stomach ( 1 - 4 ). However, it has some limitations such as lack of postoperative analgesia, tourniquet pain, insufficient muscle relaxation, and local anesthetic toxicity ( 5 , 6 ). To improve postoperative analgesia, different additives have been combined with local anesthetics during IVRA ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Magnesium Sulfate and Tramadol as an Adjuvant to Intravenous Regional Anesthesia for Upper Extremity Surgeries

et al. 2017

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BackgroundIntravenous Regional Anesthesia (IVRA) is a simple efficient method for providing regional anesthesia of the limbs. However, it has some limitations such as lack of postoperative analgesia.ObjectivesThis study aimed to compare the analgesic effects of magnesium sulfate and tramadol when added to lidocaine used for IVRA in upper limb surgery.MethodsIn this double - blind randomized clinical trial, 69 patients who underwent elective upper limb surgery with IVRA were randomly allocated into 3 groups. Patients in group A, received IVRA with 0.5% lidocaine and tramadol 100 mg, in group B received IVRA with 0.5% lidocaine and magnesium sulfate 1.5 g, while in group C patients received IVRA with 0.5% lidocaine and normal saline. The onset of sensory block and the duration of postoperative analgesia pain intensity were noted in each patient. Furthermore, the incidence of postoperative nausea and vomiting, respiratory depression, and skin rash were recorded.ResultsDuration of postoperative analgesia was more prolong in the tramadol group than other groups (P = 0.01). Also, the total amount of morphine consumption in the group A, group B, and C was 8.91 ± 5.81, 11.95 ± 4.81, 16.72 ± 4.07 mg, respectively, which was significantly lower in the tramadol group in comparison to the other groups (P = 0.01).ConclusionsIt seems that adding tramadol as an adjuvant to lidocaine during IVRA in comparison to magnesium sulfate increases duration of postoperative analgesia and decreases analgesic consumption without increasing opioid-related side effects.

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“…Similar to our findings in this study, intolerance of hematoma block analgesia was 5.8%. In the study of Jafarian et al ( 19 ), a modified Bier's block method versus the traditional one performed on patients undergoing surgery of upper limb bones showed considerable pain relief at surgical and tourniquet sites during the operation until one hour thereafter. In another study by Jafarian et al ( 20 ), pneumatic arm tourniquet as an adjunct to intravenous regional anesthesia (IVRA) provided acceptable analgesia, especially in the elderly, although it needs to be more considered in future studies.…”

Section: Discussionmentioning

confidence: 99%

Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency

et al. 2016

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BackgroundDistal radius fractures are among common fractures in the elderly. Regarding the age, background diseases, and possible risks, analgesia method is of great importance in this group.ObjectivesThe aim of this study was to compare two analgesia methods including hematoma block and general anesthesia in people over 60 years in the orthopedic emergency department.Methods68 elderly patients referring to the emergency department of a medical teaching center were selected based on the inclusion criteria for a non-randomized clinical trial. The patients were placed in two groups of 34, which were matched for age and sex. Hematoma block was used as the analgesic method in one group and general anesthesia was used in the other group. These two groups were compared for pain intensity, analgesia duration, and anesthesia side effects. The SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc., Chicago, Ill, USA) was used for data analysis.Results68 elderly patients (mean age of 70.3 ± 6.6) with a dislocated distal radius fracture which required closed reduction were examined. The duration of manipulation and surgery and discharging time were significantly different between two groups and they were all lower in the hematoma blocked group. Pain intensity evaluation indicated a statistically significant difference during initial hours after fracture reduction and fixation so that pain intensity was less in elderly patients under hematoma block than patients who underwent general anesthesia in one and six hours after surgery. Need for narcotic was 35.2% in the general anesthesia group which also showed a significant between-group difference.ConclusionsHematoma block analgesia used in distal radius fractures of the elderly is a very safe and effective method that seems preferable to general anesthesia in emergency departments.

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Efficacy of a Modified Bier's Block in Patients Undergoing Upper Limb Bone Surgery

Cited by 8 publications

References 11 publications

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

Comparison of Magnesium Sulfate and Tramadol as an Adjuvant to Intravenous Regional Anesthesia for Upper Extremity Surgeries

Hematoma Block Versus General Anesthesia in Distal Radius Fractures in Patients Over 60 Years in Trauma Emergency

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