WIP 04 - Does Hematoma Block Improve Pain Scores after Sedated Distal Forearm Fracture Reductions?

Publication Number: WIP 04.7409

Inbar Plaut, UMass Memorial Children's Medical Center, Worcester, MA, United States; Christopher Canizares, University of Massachusetts Medical School, Worcester, MA, United States; Camille Audette, UMass Memorial Children's Medical Center, Worcester, MA, United States; Erin Meyer, UMass Memorial Children's Medical Center, Natick, MA, United States

Background: The distal forearm is the most common fracture site in children. These fractures are often managed with closed reduction and casting in the Pediatric Emergency Department (PED). Ketamine is the most common drug of choice for procedural sedation since it provides analgesia, induces a dissociative state which provides anxiolysis and amnesia, and has a favorable side effect profile. Few studies have looked at the benefit of performing a hematoma block during procedural sedation with ketamine to provide additional analgesia during and after the procedure.

Objective: To evaluate the effect of hematoma block on post-procedure pain scores for patients who undergo ketamine sedation for closed reduction of distal forearm fracture.

Design/Methods: In this retrospective cohort study, we identified 524 patients that presented to the PED between 2016-2024 with a distal forearm fracture and required ketamine sedation for closed reduction. Closed reduction was performed by orthopedic or plastic surgery clinicians depending on a pre-determined call schedule. The plastic surgery team almost always performs a hematoma block during ketamine sedation, while the orthopedics team does not. We obtained IRB approval and performed a chart review to obtain data on patient demographics, pre and post-procedural pain scores, ketamine dosing, sedating clinician, adjunct pain medications, adverse events, and length of stay. We reviewed procedure notes to verify if hematoma block was performed. The primary outcome is post-procedure pain score. Secondary outcomes include total ketamine dose, adverse events, and length of stay. Chart review is ongoing with 400/524 charts completed. Descriptive statistics will be used to compare demographics between patients who received a hematoma block and those who did not. A linear regression model will be used to compare post-procedural pain scores between the two groups, as well as secondary outcomes. Binary secondary outcomes, such as presence of adverse events or success of reduction, will be analyzed with a logistic regression model to be completed by January 2025.