Perioperative pain alleviation of forearm fractures using a combination of hematoma block and intravenous regional anesthesia with the addition of ketamine and lidocaine

Introduction
Forearm fractures usually require reduction before fixation. Hematoma block (HB) is easy and efficient for the reduction of those fractures with instantaneous pain release. Intravenous regional anesthesia (IVRA) is proper for forearm surgeries; unfortunately, it is painful during lifting and wrapping the arm. A combination of HB and IVRA can bring the benefits of them both. We assessed the effect of adding ketamine to IVRA versus to HB in patients receiving both blocks for forearm fractures.
Patients and methods
This study was a prospective, double-blinded, randomized controlled trial, performed in Assiut University Hospital. Forty-four patients with closed forearm fractures needing closed reduction and internal fixation with k-wires were involved to receive combined HB and IVRA, with ketamine (0.5 mg/kg) either within the HB group A (=22) or within the IVRA group B (=22). Data collection involved the evaluation of hemodynamics, the onset of HB and IVRA, tourniquet discomfort, numerical rating scale score, first analgesia demand time, and total analgesic time.
Results
The median (range) of preoperative and intraoperative numerical rating scale scores was significantly lower in group A at the 3rd, 5th, and 10th minutes. The average time (min) with regard to first rescue analgesia was significantly higher in group A (154.5±8.169) than in group B (121.2±12.25). No significant hemodynamic changes were noticed.
Conclusion
Adding ketamine to HB in patients with forearm fractures receiving a combination of HB and IVRA can afford better analgesia throughout the conduction of IVRA and prolongs postoperative analgesia better than adding it to IVRA.