I am sure we have been round the block on this one already.
I would be fairly sure that haematoma blocks fare worse in trials thus
far mostly because of poor technique. This is partly because of
concentrating on the radial component, whereas any impacted fracture
will have seriously disrupted the triangular fibrocartilage complex on
the ulnar side, and 5 mls judiciously applied here in almost all cases
can help towards a pain free block. Sometimes need to wait 10 minutes.
I would agree with Adrian a few shots back, in that two broken wrists,
even in a stoic elderly lady, cause a lot of pain. Adding some
marcaine into the block to give longer lasting effect is kind and I have
been doing this or many years without a single adverse effect.
Paul Ransom
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: 11 December 2004 11:44
To: [log in to unmask]
Subject: Re: Bilateral Colles Fractures
Best Evidence is to use Bier's Block not Haematoma Block
http://www.bestbets.org/cgi-bin/bets.pl?record=00008
--> But that's a BET, not a GET (G=Good). The BET (Which seems very well
done) is phrased very carefully to say that it's based on the "best
evidence available at the present time ". When you consider how rare it
is for evidence they found to be BLINDED (ONE study), you wonder whether
there is a chance that we have here Bier's-lovers proving their own
case.
I can tell you that on most places I've worked it would take longer to
find the Bier's equipment than to do a haematoma block and have the
patient back to a fracturse clinic...
I believe we have here another one of MANY situations where the BEST
option is to have more than one option...
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