Bier Block in 7 steps
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- čas přidán 23. 11. 2023
- What does Bier block have to do with Beer? Nothing, of course, except that it is pronounced the same. In this video we summarize in bullet points for success and safety for Bier block. Why are we pulling this off from the dust? Well, the Bier Block is appreciated for its straightforwardness, effectiveness, and the swift recovery it allows following minor surgical procedures on the limbs. However, its success hinges on meticulous patient and surgical procedure selection and strict adherence to the technique. So - watch the video and see if it could be beneficial in your practice! Cheers!
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I would add that it is important to ensure that the patients blood pressure is not too high before performing a Bier block. I treat systolic bp above 140 mmhg. Otherwise you risk having blood flow past the tourniquet resulting in a venous tourniquet, likely a failed block and poor operating conditions for the surgeon.
Another very good video from your channel Dr. Hadzic, congratulations. I have done several bier blocks, they are very effective.
That is great to hear and thank you for the kind words.
How much pressure do you apply
Great video
Glad you enjoyed it!
Bier blocks are very good especially in mass casualties. But better if we can use Prilocaine which is not freely available
Mind explaining why would prilocaine be better?
I thought it's best to avoid it due to methemoglobinemia risk
Bier block is awesome
I needed this video, thanks
Glad it was helpful!
Is it safe to do it with non inflatable torniquet?
Hkw much pressure do you use?
For increased reliability of analgesia during carpal tunnel releases (CTR), I place an elastic IV tourniquet around the forearm near the wrist. (This is after exsanguination and main pneumatic tourniquet application). Injecting high volume (40-60mL) of 0.5% lidocaine with the elastic forearm tourniquet keeps the majority of the IV infiltrate near the surgical site. I leave the elastic tourniquet in place for about 2-3 minutes while the circulator preps. This elastic tourniquet is then removed prior to final prep and draping. This has greatly reduced break through sensation during CTR. Works well for men with big hands and arms where the local anesthetic has room to spread everywhere you don't need it.
Intraveinous lidocaine can be really toxic, when the cuff is taken off, don't the patients experience cardiac arythmias?
Prilocaine which is most suitable is not available in many places. Very useful in disaster with mass patients
What about tourniquet pain??
Will that part distal to cannula be anaesthized??
A Bier block will anesthetize parts distal to the IV insertion site. If IV is on back of hand, fingers will get numb too. Tourniquet pain is the shortcoming of this technique. Proper patient selection is important (patient must have baseline level of cooperation and tolerance for anxiety and discomfort, not appropriate for children or anxious/fidgety patients). Addition of IV sedation with versed, fentanyl and propofol helps.
Can you clearly define distal and proximal, as well as describe what to do if toeuniquet pain past 60 mins (inflate distal/blue and deflate proximal/red?) Also do you also do propofol/mac sedation/versed and fentanyl with the bier block?
Don't get too hung up on distal/proximal order, just ensure that one or both are always inflated. The point is that when one starts to hurt, you inflate the other, THEN deflate the one that was hurting. This might buy you another 10-20 min of relief. Don't expect an unsedated patient to tolerate a pneumatic tourniquet at 250mmHg for more than 20-30 min. Yes, consider using IV sedation in addition to the Bier block. It will buy you time, improve patient tolerance and experience and keeps patient blood pressure normalized if they were previously anxious. 1-2mg Versed and 50mcg fentanyl in opiate naive patient works well. You can give a 20-50mg bolus of propofol (depending on age and sedation level) just prior to applying the Esmarch for exsanguination, which is usually the most uncomfortable part. Don't forget supplemental O2 if using sedation.
@aaron159r2 thank you so much for your detailed response! I appreciate it very much!
Always thought it was Bier's Block as in his block. Have done one once to reduce a nasty Colles fracture in ED. You need proper Inflatable tourniquets. I can't think of why I'd use one now rather than an US guided block, plus most hospitals don't have double cuff tourniquets.
Fun fact whilst you'll get pain from the tourniquet it will also produce distal anaesthesia itself
The crash zooms got me
Thanks for sharing. I have two questions
1) We used to use lidocaine 2% for Bier block, what is your favourite drug?
2)we utilise two tourniquets. We start inflating the proximal one first, what is your comment on that?
Thanks.
The principal of using double tourniquet is to alleviate to tourniquet pain. In order to do so , first we inflate the proximal, then we inject the local anaesthetic, and finally, we inflate the distal then release the proximal. It is crucial to be sure that both tourniquet devices are working.
The NYSORA website has studies showing 12-15ml of 2% lidocaine is comparable to 30-50ml 0.5% lidocaine. But if you crunch the numbers, you'll see the milligram dose range for the 2% option is higher. Personally, I use 40-60mL of bicarb buffered 0.5% lidocaine. To mix up a 60mL syringe, draw up 15mL 2% lidocaine, then 30mL 8.4% sodium bicarb, then top off with 15mL normal saline for a total of 60mL. Bicarb reduces pain on injection (my personal observation). I also think it helps with faster onset and density, but academic studies don't support that. In private practice, you stick with what works the best for your patients, surgeons and facility, which studies can not always reproduce.
maybe simple nerve Block such as auxiliary would make a better job and the anaesthetist should be worry if the Turniquete really "seats"
👍🙏
I'm not interested when beer commercials come in during medical vid.
They were Bier commercials! Greetings and be comfortable! ;)
As an ICU nurse that was constantly schooled and warned about local anaesthetic toxicity, this video made me very uncomfortable!
Bier block or walant that is the question ? 😂
Worst block ever invented
Whether it's a bit lengthy process on sedation.