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Possibly I have never had any adverse effects using marcaine because I don't bother necessarily finding the 'haematoma'. Firstly because there is often impaction and this makes it difficult unless you are really determined to scrunch through osteoporotic bone, and secondly because I am a little scared of putting marcaine directly into such a vascular area. However, by creating in effect a ring block around the fracture area, I can almost always get a good block. I would be interested to measure marcaine levels after this technique, and wonder if they would be any higher than after putting equivalent amounts into a knee, say. Paul Ransom -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of James Cameron Sent: 14 December 2004 13:39 To: [log in to unmask] Subject: Re: Bilateral Colles Fractures > 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. Marcain is fantastic, but my understanding was it binds more strongly to the heart than lignocaine and therefore isn't advised for haematoma blocks (As opposed to ring or femoral nerve blocks) James Cameron. --- Incoming mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.792 / Virus Database: 536 - Release Date: 09/11/2004 --- Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.792 / Virus Database: 536 - Release Date: 09/11/2004