Skip to main content
NCBI home page
Journal of Accident & Emergency Medicine logoLink to Journal of Accident & Emergency Medicine
. 1997 Nov;14(6):352–356. doi: 10.1136/emj.14.6.352

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?

J M Kendall 1, P Allen 1, P Younge 1, S M Meek 1, S E McCabe 1
PMCID: PMC1342971  PMID: 9413772

Abstract

OBJECTIVE: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks. METHODS: This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block. RESULTS: 72 patients were recruited into the Bier's block group, and 70 into the haematoma block group. Bier's block was less painful to give than the haematoma block (median pain score 2.8 v 5.3; P << 0.001), and fracture manipulation was also less painful in the Bier's block group (median pain score 1.5 v 3.0; P < 0.01). There was no significant difference in overall A&E transit time between the two groups. There was better initial radiological outcome in terms of dorsal angulation in the Bier's block group (-3.6 degrees v 2.1 degrees; P = 0.003). More remanipulations were required in the haematoma block group (17/70 v 4/72; P = 0.003). There was a trend towards decreased pain on administration of the alkalinised haematoma block when compared with non-alkalinised haematoma block, but this did not reach significance. There was no difference in pain score on fracture manipulation. There were no complications in either group. CONCLUSIONS: Bier's block is superior to haematoma block in terms of efficacy, radiological result, and remanipulation rate; transit times are equal, both procedures are practical in the A&E environment, and there were no complications. Bier's block is the anaesthetic management of choice for Colles' fractures requiring manipulation within the A&E department.

Full text

PDF
352

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbaszadegan H., Jonsson U. Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia. Acta Orthop Scand. 1990 Aug;61(4):348–349. doi: 10.3109/17453679008993533. [DOI] [PubMed] [Google Scholar]
  2. Bartholomew K., Sloan J. P. Prilocaine for Bier's block: how safe is safe? Arch Emerg Med. 1990 Sep;7(3):189–195. doi: 10.1136/emj.7.3.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brown E. M., McGriff J. T., Malinowski R. W. Intravenous regional anaesthesia (Bier block): review of 20 years' experience. Can J Anaesth. 1989 May;36(3 Pt 1):307–310. doi: 10.1007/BF03010770. [DOI] [PubMed] [Google Scholar]
  4. Case R. D. Haematoma block--a safe method of reducing Colles' fractures. Injury. 1985 Jul;16(7):469–470. doi: 10.1016/0020-1383(85)90168-8. [DOI] [PubMed] [Google Scholar]
  5. Christoph R. A., Buchanan L., Begalla K., Schwartz S. Pain reduction in local anesthetic administration through pH buffering. Ann Emerg Med. 1988 Feb;17(2):117–120. doi: 10.1016/s0196-0644(88)80293-2. [DOI] [PubMed] [Google Scholar]
  6. Cobb A. G., Houghton G. R. Local anaesthetic infiltration versus Bier's block for Colles' fractures. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1683–1684. doi: 10.1136/bmj.291.6510.1683-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hunter J. B., Scott M. J., Harries S. A. Methods of anaesthesia used for reduction of Colles' fractures. BMJ. 1989 Nov 25;299(6711):1316–1317. doi: 10.1136/bmj.299.6711.1316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Johnson P. Q., Noffsinger M. A. Hematoma block of distal forearm fractures. Is it safe? Orthop Rev. 1991 Nov;20(11):977–979. [PubMed] [Google Scholar]
  9. Kendall J. M., Allen P. E., McCabe S. E. A tide of change in the management of an old fracture? J Accid Emerg Med. 1995 Sep;12(3):187–188. doi: 10.1136/emj.12.3.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. McGlone R., Bodenham A. Reducing the pain of intradermal lignocaine injection by pH buffering. Arch Emerg Med. 1990 Jun;7(2):65–68. doi: 10.1136/emj.7.2.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Quinton D. N. Local anaesthetic toxicity of haematoma blocks in manipulation of Colles' fractures. Injury. 1988 Jul;19(4):239–240. doi: 10.1016/0020-1383(88)90034-4. [DOI] [PubMed] [Google Scholar]
  12. Scott J., Huskisson E. C. Graphic representation of pain. Pain. 1976 Jun;2(2):175–184. [PubMed] [Google Scholar]
  13. Wardrope J., Flowers M., Wilson D. H. Comparison of local anaesthetic techniques in the reduction of Colles' fracture. Arch Emerg Med. 1985 Jun;2(2):67–72. doi: 10.1136/emj.2.2.67. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Accident & Emergency Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES