血肿块法是闭合性前臂骨折复位最有效的技术：一项回顾性队列研究。

Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study.

机构信息

Hunter New England Local Health District, New Lambton, New South Wales, Australia.

Emergency Medicine, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia

出版信息

Emerg Med J. 2024 Sep 25;41(10):595-601. doi: 10.1136/emermed-2023-213591.

DOI:10.1136/emermed-2023-213591

PMID:39019579

Abstract

BACKGROUND

Forearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block (HB), Bier's block (BB) and procedural sedation (PS).

METHODS

A retrospective multicentre cohort study was conducted of adult patients presenting to either Port Macquarie Base Hospital ED or Kempsey District Hospital ED in New South Wales, Australia, from January 2018 to June 2021. Patients requiring a closed reduction in the ED were included. ED length of stay (LOS) was compared using a likelihood ratio test. Successful reduction on the first attempt and the number of ED specialists present for each method were both modelled with a linear regression. Staff utilisation by the level of training, cost of consumables and complications for each group were presented as descriptive statistics.

RESULTS

A total of 226 forearm fractures were included. 84 used HB, 35 BB and 107 PS. The mean ED LOS was lowest for HB (187.7 min) compared with BB (227.2 min) and PS (239.3 min) (p=0.023). The number of ED specialists required for PS was higher when compared with HB and BB (p=0.001). The cost of consumables and a total number of staff were considerably lower for HB compared with PS and BB methods. PS had the highest proportion of successful reductions on the first attempt (94.4%) compared with BB (88.6%) and HB (76.2%) (p=0.006). More patients experienced complications from PS (17.8%) compared with BB (14.3%) and HB (13.1%).

CONCLUSIONS

In this study, the HB method was the most efficient as it was associated with a shorter ED LOS, lower cost and staff resource utilisation. Although PS had a significantly greater proportion of successful reductions on the first attempt, HB had fewer complications than BB and PS. EDs with limited resources should consider using HB or BB as the initial technique for fracture reduction with PS used for failed HB or when regional blocks are contraindicated.

摘要

背景

前臂骨折是急诊科常见的就诊原因。本研究旨在比较三种麻醉技术在急诊科闭合性前臂骨折复位中的资源利用情况：血肿阻滞（HB）、 Bier 阻滞（BB）和程序性镇静（PS）。

方法

这是一项回顾性多中心队列研究，纳入了 2018 年 1 月至 2021 年 6 月期间澳大利亚新南威尔士州麦夸里港基地医院急诊科和肯普西地区医院急诊科就诊的成年患者。纳入需要在急诊科行闭合复位的患者。使用似然比检验比较急诊科停留时间（LOS）。采用线性回归分别对首次尝试复位成功率和每种方法所需的急诊科专家数量进行建模。描述性统计呈现每组的人员利用率、培训水平、耗材成本和并发症。

结果

共纳入 226 例前臂骨折患者。84 例使用 HB，35 例使用 BB，107 例使用 PS。HB 的平均急诊科 LOS 最低（187.7 分钟），低于 BB（227.2 分钟）和 PS（239.3 分钟）（p=0.023）。与 HB 和 BB 相比，PS 所需的急诊科专家人数更多（p=0.001）。与 PS 和 BB 方法相比，HB 的耗材成本和总人数明显更低。PS 的首次复位成功率最高（94.4%），高于 BB（88.6%）和 HB（76.2%）（p=0.006）。PS 组并发症发生率（17.8%）高于 BB 组（14.3%）和 HB 组（13.1%）。