Abstract：
BACKGROUND: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults.
METHODS: We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction.
RESULTS: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in \'pain during reduction\' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low.
CONCLUSIONS: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.
METHODS: We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction.
RESULTS: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in \'pain during reduction\' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low.
CONCLUSIONS: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.
摘要：
背景：与其他更常用的方式相比，周围神经阻滞可以为桡骨远端骨折的闭合复位提供更好的条件。在这次系统审查中，我们评估了现有的关于周围神经阻滞对成人桡骨远端骨折闭合复位的影响和危害的证据。
方法：我们进行了一项系统评价，包括荟萃分析和试验序贯分析，包括研究使用周围神经阻滞闭合复位桡骨远端骨折的试验。共同的主要结果是（1）闭合复位的质量，以随后需要手术的参与者的比例衡量，以及（2）闭合复位期间的疼痛。
结果：6项试验（n=312）符合纳入标准。一项试验报告需要手术，25名参与者中有4名接受神经阻滞，25名接受血肿阻滞的参与者中有7名需要手术(RR0.57,96.7%CI[0.19;1.71]，p=.50）。四项试验报告了闭合复位过程中的疼痛。在荟萃分析中，神经阻滞的疼痛没有统计学上的显着减轻（-2.1数字评定量表（NRS）分（0-10），96.7%CI[-4.4；0.2]，p=.07，tau2=5.4，I2=97%，运输安全管理局调整。95%CI[-11.5；7.3]）。没有跨越试验顺序界限，并且未满足所需的信息大小。对评估超声引导的周围神经阻滞（患者=110）的试验进行的预先计划的亚组分析显示，减少过程中的疼痛显着减少（-4.1NRS，96.7%CI[-5.5；-2.6]，p<.01，tau2=0.9，I2=80%)。所有试验结果都存在高偏倚风险，证据的确定性非常低。
结论：关于周围神经阻滞闭合复位桡骨远端骨折效果的证据的确定性目前非常低。在超声引导下进行的周围神经阻滞可能潜在地减轻闭合复位期间的疼痛。高质量的临床试验是必要的。
方法：我们进行了一项系统评价，包括荟萃分析和试验序贯分析，包括研究使用周围神经阻滞闭合复位桡骨远端骨折的试验。共同的主要结果是（1）闭合复位的质量，以随后需要手术的参与者的比例衡量，以及（2）闭合复位期间的疼痛。
结果：6项试验（n=312）符合纳入标准。一项试验报告需要手术，25名参与者中有4名接受神经阻滞，25名接受血肿阻滞的参与者中有7名需要手术(RR0.57,96.7%CI[0.19;1.71]，p=.50）。四项试验报告了闭合复位过程中的疼痛。在荟萃分析中，神经阻滞的疼痛没有统计学上的显着减轻（-2.1数字评定量表（NRS）分（0-10），96.7%CI[-4.4；0.2]，p=.07，tau2=5.4，I2=97%，运输安全管理局调整。95%CI[-11.5；7.3]）。没有跨越试验顺序界限，并且未满足所需的信息大小。对评估超声引导的周围神经阻滞（患者=110）的试验进行的预先计划的亚组分析显示，减少过程中的疼痛显着减少（-4.1NRS，96.7%CI[-5.5；-2.6]，p<.01，tau2=0.9，I2=80%)。所有试验结果都存在高偏倚风险，证据的确定性非常低。
结论：关于周围神经阻滞闭合复位桡骨远端骨折效果的证据的确定性目前非常低。在超声引导下进行的周围神经阻滞可能潜在地减轻闭合复位期间的疼痛。高质量的临床试验是必要的。
