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“This will only hurt for a second.” “You're going to feel a little mosquito bite”. Doctors are famous for understating the pain of procedures. But there's no way round the fact that procedures hurt, and methods to reduce the pain themselves inflict “discomfort”. In this month's issue we report on two randomised controlled studies of techniques to reduce pain prior to a procedure. Saghi and co-investigators in Tehran compared lidocaine infiltration using a needleless jet injector vs. a 25 gauge needle in 53 patients requiring suturing of small lacerations. The jet injector technique was significantly less painful, and anaesthesia was equivalent, although it took a few minutes longer to achieve anaesthesia. This delay may explain why some prior studies found the jet injector less effective in producing anaesthesia.
In 2009, a Cochrane review concluded that haematoma blocks were inferior to IV anaesthesia for the reduction of wrist fractures. However, that was largely before ultrasound became a familiar bedside tool in the ED. Fathi et al take another look at the question. 143 patients with distal radius fracture were randomised to either IV anaesthesia with midazolam and fentanyl, …
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