TOPLINE:

Ultrasound-guided axillary nerve block (ANB) was as effective as fracture hematoma block (FHB) in providing pain control for forearm fracture reduction in emergency departments (EDs), with ANB causing less procedural pain but requiring more time, a trial showed.

METHODOLOGY:

• Researchers conducted a single-center randomized controlled trial from 2021 to 2023 and included 115 patients (age ≥ 16 years) with radiologically confirmed closed, isolated, and displaced distal forearm fractures requiring nonoperative manual reduction.
• Patients were randomly assigned to receive either ultrasound-guided ANB (n = 57; median age, 69 years; 78.9% women) performed by physicians certified in point-of-care ultrasound or FHB (n = 58; median age, 64 years; 81.0% women) performed by the patients' treating physicians.
• The primary outcome was the pain score during fracture reduction, measured using the Numeric Rating Scale (NRS; 0-10).
• The secondary outcomes included the total procedural time, defined as the time from the initiation of the block procedure to the completion of the cast, and satisfaction scores (measured using the NRS) for the physician administering the block, the physician performing the reduction, and the patient.

TAKEAWAY:

• Pain scores were not significantly different between the groups during fracture reduction (median NRS score, 4.0 in the ANB group vs 6.0 in the FHB group; P = .120), but the ANB procedure was less painful than the FHB procedure during administration (P < .001).
• The total procedure time was significantly longer in the ANB group than in the FHB group (45 vs 30 minutes; P < .001).
• A higher proportion of patients in the ANB group than in the FHB group reported clinically acceptable pain levels (NRS score, 0-4) during the block placement procedure (P < .001) and fracture reduction (P = .048).
• The reported satisfaction scores among patients and physicians did not differ between the groups (all P < .05).

IN PRACTICE:

"This single-centre randomised controlled study demonstrated that ANB compared to FHB provides comparable, if not superior, pain control for forearm fracture reduction," the authors wrote.

SOURCE:

The study was led by Bram Rook, MD, Frisius Medical Centre, Leeuwarden, Netherlands. It was published online on December 7, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by its single‑center design with a convenience sample and by several methodological challenges, including nonstandardized local anesthetic dosages between groups. These factors reduced the generalizability of the findings and introduced potential sampling and selection bias. Assessors, patients, and operators were not blinded for pain scoring, possibly leading to measurement and performance bias. Additionally, participating physicians had varying experience levels, and some had performed only the minimum required three supervised axillary nerve blocks, which may have influenced procedural efficacy.

DISCLOSURES:

One author reported receiving financial support from the Dutch Emergency Medicine Research Fund Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.