> Quinton DN
> Local anaesthetic toxicity of hematoma blocks in manipulation
> of colle's
> fractures
> Injury (1988) 19, 239 - 240
>
> Potentially toxic levels of lidocaine were found in the arterial
> circulation, with a peak in the minutes AFTER manipulation. However,
> subjectively well-tolerated by the (small group) of patients.
Thanks. Hadn't looked for the evidence. Interesting to know it's out there.
> Best Evidence is to use Bier's Block not Haematoma Block
> http://www.bestbets.org/cgi-bin/bets.pl?record=00008
As stated elsewhere, the evidence is pretty limited. The Cochrane review
which was probably a larger systematic review found insufficient evidence
either way. I'd note that the different studies in this particular review
show different results. I'd also be a bit wary on interpreting things about
haematoma block without knowing who's doing it- it's an operator dependent
technique and often done badly.
> In my own experience and observing practice of others.
> Haematoma block is
> quicker for the doctor, but not so nice for the patient. The
> majority of
> doctors don't seem to have "good technique" for a haematoma block.
I'd agree on the not so nice for the patient and frequent poor technique.
I'd note that Jason Kendall's study showed no difference in time in the
department between the techniques. This surprised me when the study first
came out, because I'd thought that Biers took longer (without having
measured it) and had tended to go for haematoma when I'd had several
patients needing manips. I'd also note that the same study showed no
difference in pain between the techniques (possibly due to good haematoma
block technique in Bristol).
Overall, I think haematoma block has it's place (either as a technique of
first choice in the right hands or as a technique when IVRA or brachial
plexus block is contraindicated; possibly in combination with conscious
sedation). The study mentioned above confirms my belief that it may be a
dodgy technique for bilateral fractures.
Matt Dunn
Warwick
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