I certainly do a lot of haematoma blocks. In my hands the injection is not painful (warmed lidocaine, small amount of local before
you try entering the haematoma) and the analgesia is fine because I wait for 15 minutes before even moving the hand. When
supination and tapping over the median nerve is painless you can manipulate.
Bear in mind I did 8 years anaesthesia, with lots of local blocks so you think I would be biased towards the Bier's block. The safety
issue is a non-starter. It was dangerous in the days of bupivacaine, of which I gave many, as if the cuff deflated the patient got a
bolus of marcain which either made them fit or gave them a cardiac arrest that was very difficult to resuscitate from. Prilocaine is a
completely different animal as it only causes methaemoglobinaemia in overdose and that is easily reversed the classical way with
methylene blue or the cool way with ascorbic acid. But it's such a fiddle! It takes a minimum of an hour and needs a doctor present
all the time. You get 10 old ladies fall over on a Thursday morning and you simply cannot cope. Its only use now in my view is for
the 12 hour + patient.
And don't forget, only manipulate those you really have to.
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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