Background Distal forearm fractures are common in children and require proper analgesia to be reduced appropriately in the pediatric emergency department (PED). While hematoma blocks have become a common form of analgesia for adult patients, few studies have examined the effect of hematoma block for pediatric patients undergoing distal forearm fracture reduction.

Methods This retrospective cohort study included children between the ages of 3 and 17 years old who were treated in a tertiary care PED between October 2017 and August 2024 with distal forearm fractures who underwent intravenous ketamine sedation for closed reduction. Data were collected from patient’s electronic medical record including pre- and post-procedural pain scores, ketamine dosing, and occurrence of any adverse events.

Results The mean age of the study population was nine years old, 34% were girls, 84% broke both bones in their forearm, and 38% received pain medication prior to arrival. Patients who received a hematoma block (n=53) had a 53% lower odds (95%CI 0.18-1.26) of having any pain post-procedurally compared with those who did not receive a hematoma block (n=168), and a 68% lower odds (95% CI 0.07-1.52) of reporting severe pain. The total ketamine dose for patients who received a hematoma block was 1.39 milligram per kilogram (mg/kg) compared to 1.5 mg/kg for the patients who did not receive a hematoma block.

Conclusion For pediatric patients undergoing ketamine sedation for distal forearm fracture reductions, hematoma blocks can provide additional analgesia.