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From: pmartin <[log in to unmask]>
To: INTERNET:[log in to unmask] <[log in to unmask]>
Date: 25 February 2000 21:15
Subject: Re: VT and acidosis


>Axillary nerve block, Simon - with 23 Ch butterfly and lignocaine or
>prilocaine - also frees up everyone as it only takes 3 minutes to do then
>the patient can sit and 'cook' for 40 minutes while you do something else.
>Ffion Davies
>Royal London
>

The only reference I have found regarding this (in the form of a trial) was
an uncontrolled trial of interscalene block - which I think is a variant of
an axillary block (says so in the paper anyway)

Unique Identifier
83150445
Authors
Hughes TJ. Desgrand DA.
Title
Interscalene block for Colles'
fractures.
Source
Anaesthesia. 38(2):149-51, 1983 Feb.

The abstract is not on Medline but they basically looked at 100 patients
(19-102 yrs). 92% of the blocks were graded as satsfactory or good.

Complications
32 ptosis
5 recurrent laryngeal nerve block
5 phrenic nerve block
5 cervical plexus block
4 systemic effects
1 aspiration of venous blood.

Despite this they thought it was a safe and simple procedure!!!!!!!!

I could not find anything specifically on axillary blocks for radial #
manipulation but it may be worth a trial if you rate it as a technique.
Jason Kendall's trial in the JAEM was a good model (as listed on the BET).
There is also a few papers on the use of midazolam (it hurts but you don't
remember it) and cubital nerve blocks [1](it hurts).

The most potentially exciting paper I found was the use of atracurium in the
Biers block to cause localised muscle relaxation (2), though the dose was
very small.

Simon

Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
Manchester
England

(1)

Authors
Haasio J.
Institution
Department of Anaesthesia, Surgical Hospital, University
Central Hospital, Helsinki, Finland.
Title
Cubital nerve block vs
haematoma block for the manipulation of
Colles' fracture.

Source
Annales Chirurgiae et Gynaecologiae. 79(3):168-71, 1990.

Abstract
Blocking efficacy and acute toxicity of prilocaine (15 ml of 10 mg/ml
prilocaine) was examined in 35 (16 + 19) patients by using blocks of the
radial, ulnar and median nerves in the elbow region (Group 1), or the
haematoma block method (Group 2) for the manipulation of Colles' fracture.
In Group 1 vs Group 2, the reposition was painless in 44% (7/16) vs 68%
(13/19), moderate pain occurred in 38% (6/16) vs 21% (4/19), and severe pain
in 19% (3/16) vs 11% (2/19). At 15 minutes there was a higher degree of
block, on average, at the median and ulnar nerve innervation areas in Group
1. Complete motor block at peripheral innervation regions of all three
nerves was achieved in only one patient in Group 1 and in no case in Group
2. Despite this, the surgeons assessed the relaxation at the wrist
satisfactory for reposition of the fracture in all but one patient (Group
2). The highest individual prilocaine plasma concentration in Group 1 was
0.68 microgram/ml at ten minutes, whereas the highest individual value in
Group 2 was 0.77 microgram/ml at ten minutes. Systemic toxicity from the
local anaesthetic did not occur.

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Citation 2
Unique Identifier
88309261

Authors
McGlone R. Heyes F. Harris P.
Institution
General Infirmary, Leeds, England.
Title
The use of muscle relaxant to supplement local anaesthetics for Bier's
blocks.

Source
Archives of Emergency Medicine. 5(2):79-85, 1988 Jun.

Abstract
In searching for the 'ideal' muscle relaxant for use with intravenous
regional anaesthesia, muscle relaxation was assessed with and without the
addition of Atracurium to Bier's Block in four volunteers. This was followed
by a clinical study of 36 patients with wrist fractures to confirm the
drug's safety and examine the possible clinical advantages of using a muscle
relaxant. The addition of 2 mg of Atracurium to the Bier's Block improved
the ease of reduction (P less than 0.025) and the quality of analgesia (P
less than 0.05) (Mann-Whitney U test). The authors conclude that the
addition of Atracurium to a Bier's Block is useful in selected patients with
a wrist fracture.

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The only reference I have found regarding this (in the form of a trial) was
an uncontrolled trial of interscalene block - which I think is a variant of
an axillary block
Simon Carley
SpR in Emergency Medicine
Manchester Royal Infirmary
Manchester
England



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