Rowley, I must speak up for the Biers block.
The requirement for a second doctor, like starvation prior to Biers, was a
recommendation made years ago, by the Royal College of Anaesthetists, I
believe, after marcain induced deaths, and that document is long obsolete.
Since the change to prilocaine (3mg/kg), no serious adverse reactions have
been reported in over 30,000 Biers blocks. I have personally seen the cuff
deflate twice, once immediately after injection...I wet myself but the
patients remained asymptomatic.
A paper in the J Trauma a few years ago showed injection into the ACF veins
was safe, a development which helps somewhat as often the hand and wrist are
swollen.
Biers is superior to haematoma block in terms of analgesia and anatomical
reduction in Colles fracture and in my opinion is safe for one trained
doctor to perform - and it is easier to learn to do properly than a
haematoma block.
Steve Meek
Emergency Medicine
RUH Bath
> ----------
> From: [log in to unmask][SMTP:[log in to unmask]]
> Sent: 11 December 1998 05:12
> To: [log in to unmask]
> Cc: [log in to unmask]
> Subject: Re: Hugh Owen Thomas
>
> In-Reply-To: <[log in to unmask]>
> Bier's block is excellent, but does require a second doctor to be
> available throughout.
>
> /Rowley./
>
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