There was insufficient robust evidence from randomised trials to establish the relative effectiveness of different methods of anaesthesia, different associated physical techniques or the use of drug adjuncts in the treatment of distal radial fractures. There is, however, some indication that haematoma block provides poorer analgesia than IVRA, and can compromise reduction.
Given the many unresolved questions over the management of these fractures, we suggest an integrated programme of research, which includes consideration of anaesthesia options, is the way forward.
Comparison of bupivacaine and prilocaine used in Bier block--a double blind trial.
The value of Bier blocks for the manipulation of fractures and for operations on the upper limb is well recognized. Two anaesthetic agents, bupivacaine and prilocaine, are widely used for this purpose. A prospective double blind trial of 200 patients has been carried out to compare the efficacy of each drug and the incidence of side effects. The study shows that bupivacaine was associated with a greater number of successful fracture reductions than prilocaine with little difference in their analgesic effects, but this was balanced by more minor side effects with bupivacaine. There was little difference in the time from injection to analgesia in the two groups. All intravenous regional analgesia procedures were carried out by junior orthopaedic or accident and emergency doctors. The overall success rate for analgesia was 91 per cent but marked cuff discomfort occurred in 9 per cent of patients. There was a clear association between failure of analgesia and two of the doctors carrying out the procedure.