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No Mike - I wasn't explicit in my 1st e-mail. As you correctly point out Midazolam is a sedative, not an analgesic. I administer incremental IV morphine [or sometimes Ketolorac] after examination and prior to X-ray for analgesia. I know some folk get a bit twitchy about using opiates and midazolam together but at the end of the day if the worst happens both agents are easily reversible and basic airway management should not be beyond our wit. I have not run into any problems myself and emphasize to juniors the importance of incremental doses, monitoring, procedure in resus etc etc Best wishes, Bill ----- Original Message ----- From: Michael Dudley <[log in to unmask]> To: <[log in to unmask]> Sent: Tuesday, October 01, 2002 12:45 PM Subject: Re: Bier's Block > Bill > > Do you mean Midazolam alone? No analgesia? Sure, patient satisfaction may be > fine but Midazolam has a great amnesic effect, so that may mean they have > forgotten the torture you put them through! > > Regards > Mike Dudley > Airedale > > ----- Original Message ----- > From: Richard BAILEY <[log in to unmask]> > To: <[log in to unmask]> > Sent: Wednesday, October 02, 2002 3:28 AM > 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 > > > > > >