Given up on Bier blocks by now, thanks to time constraints. Haematoma
blocks so much faster. My experience is that failure rate in haematoma
blocks as opposed to Biers concerns inadequate dosage of anaesthetic, and
most likely omitting to inject over the ulnar side of the wrist aswell, as
there will usually be damage here too. So, two injection sites usually,
but I can (nearly) always get excellent anaesthesia with this site. I use
marcaine, on the basis that this is what I would want for myself.
Sometimes,when the department is busy, or a long wait in x-ray, I will put
in the block on first sight, and give it a tweak, and so just get back an
x-ray in POP, if it is clinically obvious this is a Colles. Patients
usually happy to be out of the department in under an hour, if lucky.
As for the haematoma, not always possible to get into this, if there is
more of an impaction. Can't say that I've noticed any decrease in analgesia
since not routinely aspirating x mls of blood back.
Paul Ransom
A&E Brighton
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