A lot of issues coming up here!
Firstly with respect to haematoma blocks, I'm not convinced these can be
done much faster than a Bier's; I do a Bier's in less than 20 minutes, all
in, with a cuff time of 15 minutes. Secondly I find many fractures are too
impacted to allow easy access for a haematoma block, or conversely so
markedly displaced that I don't believe a local injection can effectively
anaesthetise them. Thirdly the only time I've seen toxicity (mild) was with
a haematoma block - well you are injecting local into a vascular marrow
cavity, aren't you!
I still do the occasional haematoma block however, if the patient is older
(less vascular bone) and if the fracture is suitable (can get my needle into
it easily, and which doesn't require much manipulation). I still don't get
the analgesia that I get with Bier's however (i.e. complete block). But
perhaps my haematoma technique isn't as good as it could be, so I'd be
grateful if someone (perhaps John Black) could enlighten me on their
technique, including doses, injection site and timing etc.
Adrian Fogarty
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