"Bier's Block" OR "Biers Block"

OBJECTIVES: Bier block (BB) is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet remains infrequently used in the pediatric emergency department (PED). No standardized methods of BB training have previously been described. The objective of this study was to determine whether a multimodal instructional course increases comfort with BB and translates to increased use of this technique. METHODS: A novel interdisciplinary simulation and Web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED...

BACKGROUND: In recent years, there has been a significant resurgence of interest in regional anaesthesia techniques. Despite various advantages, regional anaesthesia is not used to its full potential in orthopaedic surgeries. METHODS: This study was conducted to evaluate the efficacy and safety of regional anaesthesia techniques in 400 consecutive patients, posted for orthopaedic surgeries in a tertiary care centre. Data was analysed for patient profile, type of surgery, nature of anaesthetic technique used, success rate, complications and satisfaction level of patients...

OBJECTIVE: To compare tourniquet tolerance and postoperative analgesia using lignocaine intravenous regional analgesia alone or with addition of dexamethasone and ketorolac. METHODS: The randomised, prospective study was conducted at Mayo Hospital, Lahore, from June 2013 to June 2014. Patients were divided into three groups: group I received lignocaine; group II received lignocaine and 30mg ketorolac; and group III received lignocaine, 30mg ketorolac and 08mg dexamethasone for intravenous regional anaesthesia...

BACKGROUND: Local vasoconstrictor reflexes, the vascular myogenic response (VMR) and the veno-arterial reflex (VAR) are necessary for the maintenance of regional blood flow and systemic arterial blood pressure during orthostatic stress. Their molecular mechanism is unknown. We postulated that adenosine is involved in the activation of these local reflexes. METHODS: This hypothesis was tested in 10 healthy male volunteers (age 29 ± 3 years, BMI 24 ± 1 kg/m(2))...

REVIEW QUESTION/OBJECTIVE: The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists (ASA) class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. BACKGROUND: Both injury and deformity of the upper extremity can result in dysfunction to nerves, tendons and bones which can lead to disability and pain...

OBJECTIVE: This study was designed to evaluate the effect of different doses of midazolam on anesthesia and analgesia quality when added to lidocaine during the intravenous regional anesthesia (IVRA). METHODS: One hundred and forty patients underwent hand surgery were randomly allocated into four groups to receive 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the control Group L-C (n = 35), 30 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M1 (n = 35), 40 μg/kg midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the midazolam Group L-M2 (n = 35), and 50 μg/kg midazolam plus 3 mg/kg lidocaine 2% diluted with saline to a total volume of 40 mL in the midazolam Group L-M3 (n = 35)...

Modern anesthetic agents have allowed for the rapid expansion of ambulatory surgery, particularly in hand surgery. The choice between general anesthesia, peripheral regional blocks, regional intravenous anesthesia (Bier block), local block with sedation, and the recently popularized wide-awake hand surgery depends on several variables, including the type and duration of the procedure and patient characteristics, coexisting conditions, location, and expected length of the procedure. This article discusses the various perioperative and postoperative analgesic options to optimize the hand surgical patients' experience...

BACKGROUND: Despite the increasing use of regional anesthesia, specific recommendations regarding the type of procedures to be included in residency training programs are not currently available. We aimed to determine the nerve block techniques that practicing Chilean anesthesiologists perceived as essential to master during residency training. METHODS: After institutional ethics committee approval, an online survey was sent to 154 anesthesiologists that graduated between 2005-2012, from the two largest university residency programs in Chile...

BACKGROUND: Intravenous regional block, called the Bier's block, refers to an analgesic technique applied for soft tissue surgeries and closed bone manipulations of the limbs. There are a number of complications in traditional method of block, including pain in tourniquet site, immediate return of pain after tourniquet deflation, wound hemostasis and some others. OBJECTIVES: The aim of this study was to assess the outcomes and complications of our new method of blockage...

PURPOSE: To investigate the current treatment patterns of carpal tunnel surgery by members of the American Society of Surgeons of the Hand today and to assess how several elements of practice vary by surgeon location and experience. METHODS: An online survey consisting of 10 questions was sent electronically to members of the American Society of Surgeons of the Hand (N = 2,413). A brief description of the study and a link were sent to participants by the investigators...

This case report describes a rare side effect during a Bier's block. During local anaesthetic injection, the patient suffered a sudden onset painful petechial rash localised to the upper limb, distal to the tourniquet, without systemic effect. After deflation of the tourniquet, the pain resolved and no systemic effects were seen. The skin changes settled without treatment over one week. The discussion summarises standard technique and precautions required for a Bier's block. It also evaluates risks and complications...

The Bier block procedure has been in use for over 100 years, but only recently has received renewed attention. As emergency departments look for ways to maximize efficiency, the use of the Bier block has been recognized as effective and fast with minimal adverse effects. This article summarizes a proposed protocol for the implementation of both pre- and posthospitalization Bier blocks by healthcare providers.

BACKGROUND: Ondansetron has analgesic properties. The aim of the present study was to assess the analgesic effect of 8 mg ondansetron when added to lidocaine for intravenous regional anesthesia (IVRA). MATERIALS AND METHODS: Ninety patients undergoing hand surgery were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (Group L, n = 30) or 8 mg ondansetron plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (group LO, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL plus 8 mg ondansetron intravenously (Group IO, n = 30)...

BACKGROUND: Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting...

OBJECTIVE: Distal forearm fractures frequently require reduction in children. We set out to survey how such fractures are currently reduced at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. METHODS: A survey was completed by paediatric emergency physicians at PREDICT sites. Survey questions covered departmental guidelines and resources and individual practice, agents used and limitations of fracture management using case vignettes...

BACKGROUND: A limitation of Bier's block or i.v. regional anaesthesia (IVRA) is tourniquet pain. We hypothesized that tourniquet placement on the forearm vs upper arm during IVRA for distal upper extremity surgery may result in less tourniquet pain, lower the need for analgesic interventions, and decrease post-anaesthesia care unit (PACU) admission. METHODS: Patients for distal upper extremity surgery were randomized into upper or forearm single-cuff tourniquet placement...

Intravenous regional anesthesia (Bier block) is indicated for minor procedures such as carpal tunnel release but must be performed in the operating room. We hypothesize that preoperative peripheral nerve blocks decrease anesthesia-controlled time compared to Bier block for carpal tunnel release. With IRB approval, we reviewed surgical case data from a tertiary care university hospital outpatient surgery center for 1 year. Unilateral carpal tunnel release cases were grouped by anesthetic technique: (1) preoperative nerve blocks, or (2) Bier block...

PURPOSE: This study aimed to introduce the technique and results of a forearm Bier block for upper extremity surgery. INTRODUCTION: Various techniques of anesthesia are used for hand surgery. Intravenous regional anesthesia, the Bier block, is an effective anesthetic technique. However, there exist several disadvantages and potential complications. We present our technique and results using the forearm Bier block. MATERIALS AND METHOD: A retrospective review was performed studying our experience using forearm Bier block from May to December of 2010...

Distal radius fractures represent 1 of every 6 fractures treated in emergency departments (EDs) each year. This injury has a peak incidence within both the 5- to 24-year-old age group and the elderly female population aged 65 years and older. An understanding of the functional anatomy of the wrist fracture will greatly aid the practitioner in proper treatment and referral for these injuries. After obtaining wrist radiographs, a thorough examination must be performed. Once anesthesia is achieved (via hematoma block, sedation, or Bier block), the first line of treatment of distal radius fractures is to reduce the fracture and stabilize the bone alignment, even if it is expected that the patient will require surgical intervention...

Complex regional pain syndrome (CRPS) type I is a painful and disabling syndrome that is accompanied by physical changes in the affected extremity. It generally occurs after trauma, manifesting as pain that is out of proportion to the inciting event. Treatment of the disorder is difficult, with many patients being refractory to multiple pharmacologic regimens. Regional anesthetic techniques, including neuraxial blockade, sympathetic blockade, Bier block, or peripheral nerve catheters, have been used with varying degrees of success...