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Advantages of the Bier Block
- Ease of administration
- Rapidity of recovery
- Rapid onset
- Muscular relaxation
- Controllable extent of anesthesia
- Excellent technique for short (60 min), superficial wrist and hand surgeries
How much should you inflate the cuff on the Bier Block?
Inflate to at least 150mmHg greater than systolic, usually to 300mHg
How much and what kind of Lidocaine should you give with a Bier Block?
- Inject 40-50 ml of 0.5% Lidocaine PLAIN into the saline lock
- Inject SLOWLY (over ~5min)
How do you assess for s/s of Lidocaine toxicity when administering it ?
Question patient about perioral numbness, metallic taste in mouth (toxicity)
How quickly does the anesthetic work in a Bier Block?
Anesthesia occurs within 5 minutes of local anesthesia injection
Which cuff do you deflate in the Bier Block? (although some people keep both up)
The distal cuff
Even if it's a quick procedure, you should NEVER deflate both cuffs in the Bier Block before ___ min
20-30; Gives drug enough time to attach to tissues. If not, the patient could get toxicity from it
*IMPT TO LABEL THE PROXIMAL AND DISTAL CUFFS*Proximal cuff is ___ Distal is ___
- Proximal cuff is RED
- Distal is BLUE
What is cyclic deflation?
Drop tourniquet slowly. Down and then back up, over and over so you leak the local into your system slowly.
How do you treat systemic lidocaine toxicity ?
- ABC’s (may require intubation)
- IV thiopental/propofol/versed to treat seizures.
- If ACLS needed, it’s suggested to use amiodarone and vasopressin rather than lido
What are the effects of toxicity specific to Lidocaine?
- CNS:Early sx are circumoral numbness, tongue paresthesia, dizziness. Sensory sx tinnitus, blurred vision
What are the contraindications to the Bier Block?
- Sickle cell
- Raynaud’s Disease
- Ischemic vascular disease
- Traumatic lacerations, Crush injuries
- Severe pain
- Post op pain issues (limited post op analgesia with this technique)
- Extremity fx (pain limits exsanguinations)
Describe the "Best Practice" with Bier Block
- Check occlusion pressure (OP) before injection of Lidocaine.
- Inflation pressure for tourniquet should be at least 100 mmHg higher than the OP and not less than 300 mmHg
- Use 50 ml syringe and inject in a distal 22 ga catheter over 90 seconds
- Tourniquet should never be deflated before 20 minutesAfter 20 – 25 minutes the tourniquet should be deflated in 10 second increments with 1 min. reinflation x 3
- Double tourniquet more comfortable for pt, safe at 150 mmhg over systolic ; 300 mmHg minimum
- Always check the tourniquet and it’s inflation tubes prior to injecting