Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis
Abstract Background Procedural sedation and analgesia (PSA) and peripheral nerve blocks (NBs) are techniques to manage pain and facilitate reduction of dislocated joints or fractures. However, it is unclear if either approach provides any distinct advantage in the emergency department (ED). The aim...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12886 |
| _version_ | 1797843811484827648 |
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| author | Maybritt I. Kuypers Lars I. Veldhuis Francis Mencl Anne vanRiel Wendy A. M. H. Thijssen Ellen Tromp J. Carel Goslings Frans B. Plötz |
| author_facet | Maybritt I. Kuypers Lars I. Veldhuis Francis Mencl Anne vanRiel Wendy A. M. H. Thijssen Ellen Tromp J. Carel Goslings Frans B. Plötz |
| author_sort | Maybritt I. Kuypers |
| collection | DOAJ |
| description | Abstract Background Procedural sedation and analgesia (PSA) and peripheral nerve blocks (NBs) are techniques to manage pain and facilitate reduction of dislocated joints or fractures. However, it is unclear if either approach provides any distinct advantage in the emergency department (ED). The aim of this systematic review is to compare these 2 techniques on pain scores, adverse events, patient satisfaction, and length of stay (LOS) in the ED. Methods We performed an electronic search of MEDLINE, EMBASE, and the Cochrane Library, and references were hand‐searched. Randomized controlled trials (RCTs) comparing PSA with NBs for orthopedic reductions in the ED were included. Outcomes of interest included pain scores, adverse events, patient satisfaction, and LOS in the ED. A total of 2 reviewers independently screened abstracts and extracted data into a standardized form. The Cochrane risk‐of‐bias tool was used to evaluate study quality. The Grading of Recommendation Assessment Development and Evaluation approach was used to assess the certainty and strength of the evidence. Data on pain scores were pooled using a random‐effects model and are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results A total of 6 RCTs (n = 256) were included in a qualitative review, and 4 RCTs (n = 101) were included in the meta‐analysis. There was no significant difference in pain scores between the PSA and NB groups (P = 0.47; SMD, 0.45; 95% CI, −0.78 to 1.69; I2 = 0.94). There were less adverse events in the NB group (0%–3.3%) compared with the PSA group (0%–20%; n = 256). LOS times were consistently shorter in the NB group (n = 215). Patient satisfaction was comparable in both groups (n = 196). Conclusion Based on the available evidence, NBs performed by emergency physicians are as effective as PSA in managing pain during orthopedic reductions in the ED. NBs are associated with fewer adverse events and shorter LOS in the ED. The quality of evidence is low. |
| first_indexed | 2024-04-09T17:12:00Z |
| format | Article |
| id | doaj.art-df153299e46f481bb00ee280d366f437 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-09T17:12:00Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-df153299e46f481bb00ee280d366f4372023-04-20T05:51:41ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-02-0141n/an/a10.1002/emp2.12886Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysisMaybritt I. Kuypers0Lars I. Veldhuis1Francis Mencl2Anne vanRiel3Wendy A. M. H. Thijssen4Ellen Tromp5J. Carel Goslings6Frans B. Plötz7Department of Emergency Medicine Amsterdam University Medical Center location Academisch Medisch Centrum Amsterdam the NetherlandsDepartment of Anesthesiology Amsterdam University Medical Center location Academisch Medisch Centrum Amsterdam the NetherlandsDepartment of Emergency Medicine Penn State University Milton Hershey Medical Center Hershey Pennsylvania USADepartment of Emergency Medicine Catharina Ziekenhuis Eindhoven the NetherlandsDepartment of Emergency Medicine Catharina Ziekenhuis Eindhoven the NetherlandsDepartment of Epidemiology and Statistics Sint Antonius Ziekenhuis Nieuwegein the NetherlandsDepartment of Traumatology Onze Lieve Vrouwe Gasthuis Amsterdam the NetherlandsDepartment of Pediatrics Tergooi Ziekenhuis Blaricum the NetherlandsAbstract Background Procedural sedation and analgesia (PSA) and peripheral nerve blocks (NBs) are techniques to manage pain and facilitate reduction of dislocated joints or fractures. However, it is unclear if either approach provides any distinct advantage in the emergency department (ED). The aim of this systematic review is to compare these 2 techniques on pain scores, adverse events, patient satisfaction, and length of stay (LOS) in the ED. Methods We performed an electronic search of MEDLINE, EMBASE, and the Cochrane Library, and references were hand‐searched. Randomized controlled trials (RCTs) comparing PSA with NBs for orthopedic reductions in the ED were included. Outcomes of interest included pain scores, adverse events, patient satisfaction, and LOS in the ED. A total of 2 reviewers independently screened abstracts and extracted data into a standardized form. The Cochrane risk‐of‐bias tool was used to evaluate study quality. The Grading of Recommendation Assessment Development and Evaluation approach was used to assess the certainty and strength of the evidence. Data on pain scores were pooled using a random‐effects model and are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results A total of 6 RCTs (n = 256) were included in a qualitative review, and 4 RCTs (n = 101) were included in the meta‐analysis. There was no significant difference in pain scores between the PSA and NB groups (P = 0.47; SMD, 0.45; 95% CI, −0.78 to 1.69; I2 = 0.94). There were less adverse events in the NB group (0%–3.3%) compared with the PSA group (0%–20%; n = 256). LOS times were consistently shorter in the NB group (n = 215). Patient satisfaction was comparable in both groups (n = 196). Conclusion Based on the available evidence, NBs performed by emergency physicians are as effective as PSA in managing pain during orthopedic reductions in the ED. NBs are associated with fewer adverse events and shorter LOS in the ED. The quality of evidence is low.https://doi.org/10.1002/emp2.12886adverse eventanalgesiadislocationemergency (medicine)fracturelength of stay |
| spellingShingle | Maybritt I. Kuypers Lars I. Veldhuis Francis Mencl Anne vanRiel Wendy A. M. H. Thijssen Ellen Tromp J. Carel Goslings Frans B. Plötz Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis Journal of the American College of Emergency Physicians Open adverse event analgesia dislocation emergency (medicine) fracture length of stay |
| title | Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis |
| title_full | Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis |
| title_fullStr | Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis |
| title_full_unstemmed | Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis |
| title_short | Procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department: A systematic review and meta‐analysis |
| title_sort | procedural sedation and analgesia versus nerve blocks for reduction of fractures and dislocations in the emergency department a systematic review and meta analysis |
| topic | adverse event analgesia dislocation emergency (medicine) fracture length of stay |
| url | https://doi.org/10.1002/emp2.12886 |
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