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> I am a big fan of axillary blocks (AB), particularly in the older cooperative children.
--> In my early career as a doc, in South Africa, I did plastic surgery as a trainee and this involved quite a lot of upper limb tendon and fracture work, exploring human bites of hands (whether caused by the teeth or by the hand), etc...
There was no easy way to get into O.R. most of the time in the middle of the night (in Johannesburg, in the early 90s). I had not heard of Ketamine. When a bloodless field was not required and/or a longer procedure was anticipated, AB was the thing to do...
But there was no ultrasound... Used to mix lignocaine & bupivacaine with epi... Go blind into the sheath and try to get all 3 nerves as they exit the ax. plexus... But I was not that good at it... Most of my colleagues were getting 90% success and I was, I think, at around 80%... Which meant then having to beg & wait for a G.A, having "used up" the allowance of lignocaine...
Still, in more expert hands than mine, I am sure it's great.
> ...If they get queasy, I don't let the patients see the fx being manipulated
--> Ahh, Ketamine... ;-)
And I used to find that the noise of the fracture realigning often used to affect me more than the sight... ;-)
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