Change of Injection site during Bier’s block anaesthesia for colles’ fracture
Date First Published:
December 22, 2001
Last Updated:
December 22, 2001
Report by:
Muhammad Ahmad, SpR IN A&E (Manchester BETS)
Search checked by:
to be checked, Manchester BETS
Three-Part Question:
In [patients with colles' fracture] does [injection proximal to the fracture site during Biers' block anaesthesia ] reduce [effectiveness of anaesthesia]
Clinical Scenario:
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.
Search Strategy:
Medline 1966 to 12.2001, using WebSPIRS
Search Details:
[exp Bier's block] AND [change of injection site]
Outcome:
49 papers were found and only one was relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Bier's Block: A change of injection site. Blyth MJ, Kinninmonth AW, Asante DK. 1995 UK | 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 |
Author Commentary:
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.
Bottom Line:
Injection proximal to the fracture site during Biers' block anaesthesia is safe and as effective as distally placed injection.
References:
- Blyth MJ, Kinninmonth AW, Asante DK.. Bier's Block: A change of injection site.