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No it is evidence based.....................
 

Authors

Kendall JM. Allen P. Younge P. Meek SM. McCabe SE.

Institution

Accident and Emergency Department, Frenchay Hospital, Bristol, UK.

Title

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best? [see comments.].

Comments

Comment in: J Accid Emerg Med. 1998 May;15(3):207 ; 9639195

Source

Journal of Accident & Emergency Medicine. 14(6):352-6, 1997 Nov.

Abstract

OBJECTIVE: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks. METHODS: This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block. RESULTS: 72 patients were recruited into the Bier's block group, and 70 into the haematoma block group. Bier's block was less painful to give than the haematoma block (median pain score 2.8 v 5.3; P << 0.001), and fracture manipulation was also less painful in the Bier's block group (median pain score 1.5 v 3.0; P < 0.01). There was no significant difference in overall A&E transit time between the two groups. There was better initial radiological outcome in terms of dorsal angulation in the Bier's block group (-3.6 degrees v 2.1 degrees; P = 0.003). More remanipulations were required in the haematoma block group (17/70 v 4/72; P = 0.003). There was a trend towards decreased pain on administration of the alkalinised haematoma block when compared with non-alkalinised haematoma block, but this did not reach significance. There was no difference in pain score on fracture manipulation. There were no complications in either group. CONCLUSIONS: Bier's block is superior to haematoma block in terms of efficacy, radiological result, and remanipulation rate; transit times are equal, both procedures are practical in the A&E environment, and there were no complications. Bier's block is the anaesthetic management of choice for Colles' fractures requiring manipulation within the A&E department.

 

Ray McGlone

----- Original Message -----
From: [log in to unmask] href="mailto:[log in to unmask]">Andrew Webster
To: [log in to unmask] href="mailto:[log in to unmask]">[log in to unmask]
Sent: Sunday, September 29, 2002 3:28 PM
Subject: Re: Bier's Block

In Sheffield we use 0.5% Prilocaine sourced from Southmead hospital pharmacy. So much more superior anaesthesia than haematoma block (personnel unblended anecdoctes off course not RCT level evidence).

 

Andy Webster

 

-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Ray McGlone
Sent: 29 September 2002 15:14
To: [log in to unmask]
Subject: Bier's Block

 

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