I quite agree. Haematoma block works well for us and our patients.
Our patient satisfaction surveys / audits give us a 5% "would prefer
another method" group.
>In our department the haematoma block is our preferred choice of
anaesthesia
>for displaced distal radial fractures in adults because:
>
>1. It is simple and safe for junior clinicians
>2. It provides effective analgesia IF properly performed
>3. It can be performed as soon as the patient arrives in the ED
>4. It can be performed in minor side without need for additional resources
>(monitoring/staff).
>5. Infection is not a problem.
>6. Satisfactory reduction can be achieved at least initially.
>
>We have regularly audited our practice and have been satisfied with the
>outcome. All our discharged patients are seen within 24 hours of the
>reduction by a consultant trauma surgeon 365 days a year.
>
>I have seen senior clinicians have significant complications with axillary
>nerve blocks and would not recommend its routine use in the ED.
>
>The logistics of undertaking a Bier's block in many of our local
department
>frequently necessitates delayed reductions and a second reattendence for a
>primary procedure depending on the timing of presentation and capacity in
>the ED.
>
>The key to success with the haematoma block, as with any procedure, is the
>quality of the training.
>
>John Black
>Oxford
>
>-----Original Message-----
>Wrom: VIBGDADRZFSQHYUCDDJBLVLMHAALPTCXLYRWTQTIP
>Sent: 30 September 2002 07:49
>To: [log in to unmask]
>Subject: Re: Bier's Block
>
>
>Regarding the "allergic reaction" with Citanest the following is worth
>reading. The without preservative Prilocaine was primarily used for
>epidurals by orthopods in our area.
>
>Ray McGlone
>A&E Lancaster
>
>Authors
>
>Kajimoto Y. Rosenberg ME. Kytta J. Randell T. Tuominen M. Reunala T.
>Rosenberg PH.
>
>Institution
>
>Department of Anaesthesiology, Helsinki University Central Hospital,
>Finland.
>
>Title
>
>Anaphylactoid skin reactions after intravenous regional anaesthesia using
>0.5% prilocaine with or without preservative--a double-blind study.
>
>Source
>
>Acta Anaesthesiologica Scandinavica. 39(6):782-4, 1995 Aug.
>
>Local Messages
>
>Held at BMA Library
>
>Abstract
>
>Methylparaben, the preservative of various local anaesthetic solutions, is
a
>potential allergen. In a double-blind study, 0.5% prilocaine with
(Citanest,
>n = 100) or without (n = 100) methylparaben were compared for the
occurrence
>of skin reactions after intravenous regional anaesthesia of the arm in
>surgical patients. Skin reactions were registered after the deflation of
the
>tourniquet cuff, and intradermal tests were performed with 0.5%
prilocaine,
>0.1% methylparaben and saline in all patients. Seventeen patients in the
>Citanest group and four patients in the methylparaben-free prilocaine
group
>developed erythematous skin reactions in the exposed arm after deflation
of
>the tourniquet cuff (P < 0.05, between the groups). The skin symptoms
>disappeared within an hour and were always restricted to the region which
>had been anaesthetised. None of the affected patients had positive
>intradermal tests. The observed skin reactions are probably
non-IgE-mediated
>anaphylactoid reactions in which the presence of methylparaben in the
local
>anaesthetic solution plays a major role.
>
>
>
>
>
>----- Original Message -----
>Wrom: WIGYOKSTTZRCLBDXRQBGJSNBOHMKHJYFMYXO
>To: <[log in to unmask]>
>Sent: Sunday, September 29, 2002 10:29 PM
>Subject: Re: Bier's Block
>
>
>> been round the houses on this one Ray. Forced to
>> changhe to lignocaine when prilocaine without
>> preservative unavailable, mailed the list about it and
>> found some using prilocaine with preservative although
>> alleged risk of reaction, others still getting it
>> without preservative, others using lignocaine.
>> Reasonable anecdotal reports of widespread antepodean
>> use of ligno w/o problems.
>> I had several probs with lignocaine: useing
>> 200mg,failures due to insufficient doseage I think
>> with beefy forearms, and symptomatic reactions to cuff
>> leakage at the same dosage in other patients. Cuff
>> leak with prilocaine happened to me twice without
>> symptoms (to patients of mine I mean).
>> Now at Frenchay using prilocaine 1% diluted down to
>> 40mls )0.5% without problems......this variation in
>> supply across the region and reasons given for it
>> leaves me confused.
>> bottom line is, I am sure prilocaine is safer than
>> lignocaine and agree with Ray that it is then a safe
>> SHO procedure: staring patients, 2 doctors being
>> present etc is unneccessary
>> steve meek
>> frenchay
>> -- Ray McGlone <[log in to unmask]> wrote:
>> > We had a locum A&E Consultant in Lancaster from the
>> > deep south, who stated that many departments in
>> > London had stopped doing Bier's Blocks after Astra
>> > withdrew 0.5% Prilocaine. How many of you have
>> > stopped using Bier's block for this reason?
>> >
>> > 0.5% Prilocaine is still available from Switzerland
>> > (with German / French inserts!) and plain Prilocaine
>> > 0.5% in 10 ml ampoules is still available from a
>> > hospital sourse. The latter will have a shorter
>> > shelf life.
>> >
>> > Alternatively one can use 1% Prilocaine followed by
>> > a saline flush to preserve total volume injected but
>> > using the same dose of Prilocaine. Peter Cutting SpR
>> > presented the results of a study at the Edinburgh
>> > conference.
>> >
>> > Interestingly a found a paper implying that 0.75%
>> > Prilocaine was the best concentration... but Astra
>> > have probably not seen it! The authors would have
>> > been using Bier's block for a number of indications
>> > not just colles fracture manipulation.
>> >
>> > Authors
>> >
>> > Prien T. Goeters C.
>> >
>> > Institution
>> >
>> > Klinik und Poliklinik fur Anasthesiologie und
>> > operative Intensivmedizin der Westfalischen
>> > Wilhelms-Universitat Munster.
>> >
>> > Title
>> >
>> > [Intravenous regional anesthesia of the arm and foot
>> > using 0.5, 0.75 and 1.0 percent prilocaine].
>> > [German]
>> >
>> > Source
>> >
>> > Anasthesie, Intensivtherapie, Notfallmedizin.
>> > 25(1):59-63, 1990 Feb.
>> >
>> > Abstract
>> >
>> > Quality of anaesthesia and risk of intoxication are
>> > competing principles in IVRA. To evaluate the
>> > optimal prilocaine concentration with injection of
>> > 40 ml, 300 patients were randomly allocated to
>> > receive either a 0.5 (PRI 0.5), 0.75 (PRI 0.5) or a
>> > 1.0 (PRI 1.0) per cent solution. Using PRI 0.5,
>> > fifteen patients required supplementary fentanyl,
>> > with PRI 0.75 one, and with PRI 1.0 two (p less than
>> > or equal to 0.05). General anaesthesia proved
>> > necessary in three patients of the PRI 0.5 and 0.75
>> > groups, respectively, and in one patient of the PRI
>> > 1.0 group (NS). With PRI 1.0 seven patients had
>> > subjective signs of intoxication upon tourniquet
>> > release, with PRI 0.75 none, and with PRI 0.5 one (p
>> > less than or equal to 0.05). Objective symptoms of
>> > local anaesthetic toxicity were not observed. The
>> > incidence of tourniquet-related pain was 25-30% in
>> > all three groups and not related to the prilocaine
>> > concentration. In conclusion, with 40 ml injection
>> > volume the 0.75% solution of prilocaine offers the
>> > optimal relation between incidence of anaesthesia
>> > and risk of intoxication.
>> >
>> >
>> >
>> > Regards
>> >
>> > Ray McGlone
>> >
>> > A&E Consultant
>> > Royal Lancaster Infirmary / Westmorland General
>> > Hospital
>> >
>> >
>> http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm
>> >
>>
>>
>> __________________________________________________
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>
>
>
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