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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