Biers block
Clinical Procedure
 
Aliases:
Bier's Block

Topic aliases are alternate phrasings for a particular topic.


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Ensure adequate resuscitation equipment and drugs are available.

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If a long acting, cardiotoxic local anaesthetic like bupivicaine or ropivicaine is inadvertantly used, leave the cuff up for more than 2hrs, have patient monitored, intralipid ready to administer if needed, and deflate cuff slowly and incrementally whilst monitoring for signs and symptoms of local anaesthetic toxicity.

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Inflate cuff to 200mmHg above systolic blood pressure. refl.in/n7

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Bupivacaine is particularly cardiotoxic and should never be used in a Biers block. refl.in/b9

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Lignocane 0.5% 0.6ml/kg (3 mg/kg) to a max of 40ml. Takes 5-10min for onset of analgesia. Release torniquet at least 20min after lignocaine infusion. refl.in/n7

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1. Before inflating the cuff, raise the arm and place pressure over the brachial artery for 1 min to drain the venous circulation.
2. Place padding around the arm underneath the torniquet to help reduce discomfort.
3. Administer the local anaesthetic slowly to monitor for central effects that might suggest cuff failure.

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Prilocaine dose 6mg/kg. Wait 30 minutes after administration of bupivicaine before deflating the limb torniquet. #ref

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Reliable regional technique for reduction of forearm fractures in patients over the age of 5 years.

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