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We still use midazolam for those deemed fit for sedation - it's what we're used to and proficient at doing. I was always put off haematoma blocks by my old Othro Prof in my previous life on the basis of infection but this doesn't seem to be a real-world problem and we use them for those we can't sedate. Surely either way if you have the anaesthetic service available it should be lovingly embraced - not many of us are that lucky though. Not as happy with the quality of reductions using blocks as when sedated and have recently started to use Chinese finger trap traction plus opiates after having found the modern version of finger traps in the Ortho Theatre (used for distracting the shoulder in arthroscopy). The literature sounds good and limited experience so far seems good - the important thing is that it's what I would choose as a first off if I bust my wrist tonight and it was going to be treated by closed means (my previous life would send me seeking a decent external fixationist but that's another story). Nick Jenkins A&E Consultant Abergavenny http://www.ae-nevillhall.org.uk -----Original Message----- From: Richard BAILEY [mailto:[log in to unmask]] Sent: 02 October 2002 03:29 To: [log in to unmask] Subject: Re: Bier's Block Is anyone else out there using sedation [midazolam] for this? Our Biers tournequet passed away a couple of years ago and I got fed up with waiting for our business manager to stump up the cash to replace it. I've never been a big fan of the "haematoma block" having witnessed the orthopods [ab]using the technique in their torture chambers. I therefore extended the sedation policy we were already using for dislocated shoulders etc with advice re low incremental doses in the elderly, in resus, full monitoring etc. To date [touch wood] no problems, good results [orthos not moaning], and satisfied patients [SHO audit project earlier this year] Best wishes, Bill Bailey ----- Original Message ----- From: Adrian Fogarty <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, September 30, 2002 6:40 PM Subject: Re: Bier's Block > 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 >