By Dr Sara Hunt and Dr Sue Catling
26 yr old man with compound fracture of tibia and fibula after falling from palm tree.
Horrible injury, with bone coming through the skin and the lower leg almost turned round the wrong way. Despite the pain the patient was uncomplaining and, although he had lost a fair amount of blood, this hadn’t been life –threatening up to now!
The surgeon had to put it back in place and fixate it- an excruciatingly agonising procedure - without an anaesthetic. The anaesthetic student planned to use just morphine for this procedure which would have been inadequate pain relief. Sara suggested a spinal anaesthetic (what we would do in the
Student then wanted to give 2mls 5% lignocaine. We checked the dose and suggested 1ml. Resident anaesthetist not present, we suggested student called him. Spinal performed from head end (NB although appropriate for this case apparently in liberia they always use this approach, which is awkward for the anaesthetist to bend around - perhaps we should advise to change this?), good asepsis, no gown, 22G Quincke needle – didn’t work, repeated, immediate effect, patient smiling.
We felt disappointed that despite the students’ theoretical knowledge, with teaching all day about pain control and spinals, that this was not translated into practise.
It appears that pain relief is not regarded as a basic need here – we take it for granted in the UK, but perhaps it is a luxury if you don’t have the necessary resources. The fascinating thing is that they did have the resources they needed for this- so why didn’t they think to use them?
Is this a cultural difference to the role of analgesia??? Or is it something we can correct with the right education?
Afterwards much needed beers at the hospital cafe – The Flagpole, where we devised a plan to use the whole incident as teaching scenario tomorrow.