Emergency medicine journal : EMJ
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Multicenter Study
Haematoma block is the most efficient technique for closed forearm fracture reduction: a retrospective cohort study.
Forearm fractures are a common ED presentation. This study aimed to compare the resource utilisation of three anaesthetic techniques used for closed forearm fracture reduction in the ED: haematoma block (HB), Bier's block (BB) and procedural sedation (PS). ⋯ In this study, the HB method was the most efficient as it was associated with a shorter ED LOS, lower cost and staff resource utilisation. Although PS had a significantly greater proportion of successful reductions on the first attempt, HB had fewer complications than BB and PS. EDs with limited resources should consider using HB or BB as the initial technique for fracture reduction with PS used for failed HB or when regional blocks are contraindicated.
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A shortcut review of the literature was conducted to examine whether administering a sphenopalatine ganglion (SPG) block provides symptomatic relief in adult patients with acute migraine. 381 papers were found of which 4 included data on patients relevant to the specific clinical question, these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that to date there is not enough evidence that a SPG block is likely to provide sustained symptomatic relief of acute migraine in the emergency setting. Further work is needed to establish if it can provide benefit for this patient group.