Comment on "novel technique in ED: supracondylar ultrasound-guided nerve block for reduction of distal radius fractures"

We have read with great attention the work “Novel technique in ED: supracondylar ultrasound-guided nerve block for reduction of distal radius fractures”, by Aydin and colleagues. The authors presented four patients with distal radius fracture and given a radial nerve anesthetic block in order to perform painless bone reduction. The block was performed by the help of ultrasound (US). This paper is informative and it may represent a possible guide for physicians in emergency conditions. The authors, in fact, show the high usefulness of this block technique, which represents a possible approach for the treatment of distal radius fracture. As they wrote, other methods are possible (hematoma block, intravenous regional anesthesia, procedural sedation analgesia, nitrous oxide and general anesthesia) [2]. Evidence exist about the efficacy of these techniques, but some possible side effects may occur. Most important, Aydin and colleagues show the importance of US-guided nerve block. This assistance is crucial, because US is able to quickly asses and precisely identify nerve position. US allows performing the procedure knowing the correct site of injection and limiting possible errors. US is, in addition, safe for patients and it may be even used in cases where the other imaging techniques have to be avoided [3]. Furthermore, from our point of view, anatomical variations are possible in some patients requiring nerve block [4]. In this case, US can rapidly provide morphological information about the nerve necessary to perform a correct anesthetic procedure. Moreover, after a trauma, specific local alterations, like foreign bodies or bone fragment, can be present. Identification of these conditions may give diagnostic data and support nerve block procedure [5,6]. Finally, the authors underline the importance of aspiration, before injection, to confirm that the needle is not inside a vessel. Indeed, US is able to support this confirmation, because it can identify the vessels and, hence, the operator can avoid the incorrect needle positioning. For this aim, the use of color and power Doppler should be considered. In conclusion, we agree with Aydin and colleagues about the high usefulness of nerve block in cases of radial bone reduction, especially if the operator is assisted by US.