Priority 21 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: What is the best form of anaesthetic (medication to stop patients feeling pain) to reduce an upper limb fracture (put it back into its normal position) in people over 50?   (JLA PSP Priority 21)
Overall ranking 21
JLA question ID 0093/21
Explanatory note When a patient breaks their arm, we try to put it back into the same position as it was before they broke it. This can be a painful procedure and so we give medication to the patient to stop them feeling any pain. This question looks to determine what is the best medication and the best way to give it, to ensure the patient does not feel pain whilst their bone is returned to its original position.
Evidence

National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management (NG38). London: NICE, 2016. 

The British Society of Surgery for the Hand. Best Practice for management of Distal Radius Fractures (DRFs). BSSH, 2018
Health Research Classification System category  Injuries and Accidents
Extra information provided by this PSP
Original uncertainty examples What is the best medication to reduce wrist fractures? ~ How often do reductions have to happen without adequate pain relief? ~How is pain relief best administered in A/E when reducing a fractured/dislocated shoulder, eg sedation, entonox, etc? ~ Local or general anaesthesia for the reduction process - how decide?
Submitted by  13 x Healthcare Professionals, 9 x Patients, 1 x Not stated
PSP information
PSP unique ID 0093
PSP name Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP. 50  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 December 2018