Three Part Question
In [patients with colles' fracture] does [injection proximal to the fracture site during Biers' block anaesthesia ] reduce [effectiveness of anaesthesia]
A 70 year old women presents to the A&E department with fracture of the distal radius, which requires manipulation. During the administration of Biers' block you failed to cannulate a vein distal to the fracture site. You wonder whether cannulation of vein at antecubital fossa is safe and effective.
Medline 1966 to 12.2001, using WebSPIRS
[exp Bier's block] AND [change of injection site]
49 papers were found and only one was relevant
|Author, date and country
||Study type (level of evidence)
|Blyth Mj, Kinninmonth AW, Asante DK|
|100 patients with colles' fracture, randomly selected into two groups of 50. In the first group, the injection site was dorsum of the hand and in the second group, injection was into the antecubital fossa.||PRCT||Pain at fracture site|| No significant difference||No power calculation|
|Pain at cuff|| No significant difference|
|Injection site bleeding||Hand-5 Antecubital fossa-0|
|Injection site haematoma||Hand-5 Antecubital fossa-0|
The onset of sufficient anaesthesia was delayed by an average of about 5 minutes in the proximally injected group. The theoretical danger of cuff leak with proximal injection is not borne out clinically, if the slow injection speed is maintained with cuff pressure of 300 mmHg.
Clinical Bottom Line
Injection proximal to the fracture site during Biers' block anaesthesia is safe and as effective as distally placed injection.
- Blyth MJ, Kinninmonth AW, Asante DK. Bier's Block: A change of injection site. The Journal of Trauma-Injury Infection and Critical care. 1995;39(4):726-728.