Intravenous regional anaesthesia (Bier’s block) for pediatric forearm fractures in a pediatric emergency department—Experience from 2003 to 2014

Chua, Ivan Si Yong; Chong, Shu Ling; Ong, Yong-Kwang Gene

doi:10.1016/j.injury.2017.10.027

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…12 Likewise, Chua et al found that overall LOS was 68 min shorter for Bier's block than ketamine in a Singaporean audit of paediatric forearm fractures. 13 As with our study, neither of these studies reported any major complications associated with either method.…”

Section: Discussionsupporting

confidence: 76%

“…15 Additionally, because a Bier's block requires patients to maintain a greater degree of awareness, to comply with the procedure and to vocalise the effects of potential local anaesthetic toxicity, ketamine PSA may remain a preferable method for certain patientsparticularly younger ones. 13 Concomitant with greater awareness, intravenous cannulation and pressure cuff inflation may also be a more painful and/or traumatising experience for younger patients in comparison to ketamine, which can be administered intramuscularly.…”

Section: Discussionmentioning

confidence: 99%

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Length of stay outcomes in patients receiving ketamine sedation versus Bier's block anaesthesia for procedural closed fracture reduction: A retrospective audit of paediatric emergency department patients

Kwong

Aldridge

Jayawardana

et al. 2021

Emerg Medicine Australasia

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Objective: To compare length of stay (LOS) for paediatric patients receiving ketamine sedation or Bier's block anaesthesia for procedural closed fracture reduction. Methods: We conducted a retrospective audit of paediatric ED patients aged 3-18 years presenting at one of three metropolitan hospitals in Victoria, Australia (2012. Outcomes were post-procedural LOS (PPLOS), total LOS, incidence of ketamine and Bier's block procedures, and recorded adverse effects. Groups were compared using t-tests. Association between treatment group and admission to a short stay unit (SSU) was assessed using univariate logistic regression. Results: Across all three sites, 449 patients were included, 379 of whom received ketamine sedation and 73 of whom underwent Bier's block anaesthesia. Mean age was 9.1 years (ketamine group: 8.3 years; Bier's block group: 13.1 years). Median PPLOS was 75 min shorter for patients who received a Bier's block than for those sedated with ketamine (P < 0.001). Patients sedated with ketamine were also 9.01 times more likely to be admitted to an SSU than those who received Bier's block anaesthesia (95% confidence interval 3.82-21.31, P < 0.001). Ketamine sedation was more common than Bier's block across the three sites. No major adverse events occurred in either group. Conclusion: Bier's block anaesthesia is a safe alternative to ketamine sedation for paediatric patients presenting to the ED with closed fractures. It is associated with reduced LOS and need for post-procedural observation. However, ketamine may remain preferable for younger paediatric patients, on whom it places fewer demands for cooperation.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Length of stay outcomes in patients receiving ketamine sedation versus Bier's block anaesthesia for procedural closed fracture reduction: A retrospective audit of paediatric emergency department patients

Kwong

Aldridge

Jayawardana

et al. 2021

Emerg Medicine Australasia

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“…18 A study done in paediatric forearm fracture reduction using Bier's block concluded that it is a safe technique. 19 There was no incidence of haemodynamic disturbances in the form of hypotension, bradycardia or other side effects at any time throughout the study. Thus, indicating that magnesium sulphate is a safe drug.…”

Section: Discussionmentioning

confidence: 83%

Evaluation of Analgesic Effect of Magnesium Sulphate in Intravenous Regional Anaesthesia- A Double Blind Study

Kumar¹,

Thabah²

2018

jebmh

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BACKGROUNDMagnesium antagonizes N-Methyl-D-Aspartate receptor, the receptor known to play an important role in the mechanism of pain. This study was undertaken to determine the effect of magnesium sulphate as an adjunct to lignocaine in Intra-Venous Regional Anaesthesia (IVRA). To evaluate the onset of anaesthesia, dose requirement of lignocaine, postoperative analgesia in upper limb surgeries. MATERIALS AND METHODSThis study was designed as a prospective, double blinded, randomised trial consisting of sixty patients. All selected patients were randomly divided into two groups. Saline group (n=30) who received fifteen millilitres of normal saline intravenously and magnesium group (n=30) who received magnesium sulphate 500mg in fifteen millilitre volume intravenously into the limb to be anaesthetised. Five millilitres of 1% lignocaine (preservative free) was administered every fifteen minutes and patients were assessed for loss of sensory and motor power, lignocaine requirement and postoperative analgesia. Data were analysed using Tukey and multivariate test. RESULTSThe mean time required to achieve surgical anaesthesia in magnesium group was 30.67±5.04 min and 53.17±5.65 min in saline group. Total dose of lignocaine required was 73.33±25.3 mg in magnesium group and 160.00±20.34 mg in saline group. Morphine requirement was 2.44±1.00 mg in magnesium group and 5.65±2.04 mg in saline group. Data showed statistically significant difference between the two groups (p=0.00). CONCLUSIONIt was concluded that magnesium as an adjunct fastens the onset of anaesthesia, reduces lignocaine requirement and prolonged postoperative analgesia. However, there was an increased incidence of transient pain with magnesium sulphate.HOW TO CITE THIS ARTICLE: Kumar M, Thabah R. Evaluation of analgesic effect of magnesium sulphate in intravenous regional anaesthesia-a double blind study.

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“…Hematoma blocks are better than Entonox, with significantly less pain and better patient acceptance [6]. Bier's block is associated with a shorter length of stay in the emergency department compared to ketamine [17]. A study by Mohr on 1,804 patients undergoing Bier's block reported only nine patients with adverse effects, and the procedure was considered safe and effective [18].…”

Section: Discussionmentioning

confidence: 99%

Pain Perception During the Phases of Manual Reduction of Distal End Radius Fracture With a Periosteal Block

Ali¹,

Soh²,

Abdullah³

et al. 2021

Cureus

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Introduction Closed reduction is an effective method of treatment for distal end radius fractures. We present a case series of patients with distal end radius fractures who underwent closed manipulative reduction using the periosteal block. We describe the technique in detail and examine its efficacy in pain lowering effect during closed reduction. Methods Nineteen patients with distal end radial and ulnar fractures were included and grouped based on the Frykman classification. The reduction was performed using a periosteal block of 10 ml of 2% lignocaine injection. The severity of pain was recorded by utilizing the visual analog scale (VAS) in five phases: 1) before injection, 2) after 15 minutes of analgesia in a resting position, 3) during minimal motion, 4) during full manipulation and reduction, and 5) post-procedure. The VAS scoring was classified as painless (VAS score of 0), mild pain (VAS score between 1-3), and painful (VAS score of 4 and above). Results The study included 19 patients [median age of 53 years (range: 18-88 years)]; there were 11 (58%) males and eight (42%) females. The mechanism of injury was a fall (n=12, 63%) or a motor vehicle accident (n=7, 37%). There was a statistically significant reduction of pain between phase one and all the other phases. Between the different fracture configurations, there was no significant difference in pain reduction. The most painful phase was expected to be phase four, ie, during full manipulation, in which four (21%) patients had a VAS score of 0, 12 (63%) patients had a VAS score between 1-3, and three (16%) patients had a VAS score of 4. Thus, 16 out of 19 patients (84%) had no or minimal pain during the most painful phase. There were no complications from the periosteal blocks. Conclusions The periosteal nerve block is an effective procedure providing satisfactory analgesia during the reduction of distal radial and ulnar fractures. It has no side effects and is free from complications associated with conventional sedation.

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Intravenous regional anaesthesia (Bier’s block) for pediatric forearm fractures in a pediatric emergency department—Experience from 2003 to 2014

Cited by 8 publications

References 11 publications

Length of stay outcomes in patients receiving ketamine sedation versus Bier's block anaesthesia for procedural closed fracture reduction: A retrospective audit of paediatric emergency department patients

Length of stay outcomes in patients receiving ketamine sedation versus Bier's block anaesthesia for procedural closed fracture reduction: A retrospective audit of paediatric emergency department patients

Evaluation of Analgesic Effect of Magnesium Sulphate in Intravenous Regional Anaesthesia- A Double Blind Study

Pain Perception During the Phases of Manual Reduction of Distal End Radius Fracture With a Periosteal Block

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