The advantages and disadvantages of Bier's blocks and haematoma blocks for Colles' fractures in A&E.
In the author's current area of practice the use of either the Bier's block or haematoma block for manipulating distal radial fractures seems to have been based mostly on the A&E consultant's preference. The purpose of this literature review was to determine if there was sufficient evidence on the advantages and disadvantages of each method of regional anaesthesia to advocate the general use of one and the exclusion of the other. When reviewing the literature the author specifically looked in to three key areas to answer this question: 1) the patient's perception of pain experienced during and after the manipulation; 2) patient safety i.e. the documented risks of the anaesthetic type used; and 3) the success of the manipulation as determined by repeat radiographs immediately after the application of a plaster of Paris cast.
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A & E Department, University Hospital Lewisham, London SE13 6LH, UK. heshedu@arsenalfc.net
D000772:Anesthesia, Local / Q000009:adverse effects* / Q000379:methods* / Q000451:nursing / Q000592:standards; D002370:Casts, Surgical; D003100:Colles' Fracture / Q000628:therapy*; D004638:Emergency Treatment / Q000009:adverse effects* / Q000379:methods* / Q000451:nursing / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D008349:Manipulation, Orthopedic; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods* / Q000451:nursing / Q000592:standards; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D012449:Safety; D016896:Treatment Outcome