Forearm Bier block: a new regional anesthetic technique for upper extremity surgery.

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. The technique involves exsanguination of the forearm and inflation of a pneumatic tourniquet placed distal to the elbow joint. Twenty-five milliliter of 0.5% lidocaine is injected intravenously. One hundred five patients underwent hand surgery using this technique. There were 53 females and 52 males with a median age of 56 years. In total, 121 procedures were performed. Patients were interviewed by telephone 24 hours postoperatively.

RESULTS: All patients received adequate anesthesia from the block. There were no intraoperative and no postoperative complications. There were no mechanical or tourniquet problems. Average tourniquet time was 10.1 minutes. Total operating time was less than 30 minutes.

DISCUSSION: Forearm Bier block presents several advantages over standard upper arm technique. Conventional Bier block involves a double tourniquet and a significant amount of lidocaine, which has potential cardiac and neurologic toxicity. Consequently, minimum tourniquet inflation time is 30 minutes. The dosage of lidocaine needed to provide analgesia using the forearm Bier block is significantly reduced, thereby minimizing the potential for these complications. This lower dose allows for shorter tourniquet time rather than the standard 30 minutes. This shorter tourniquet time in itself presents several advantages. Tourniquet pain and risk of ischemic problems are minimized, and efficiency is increased. This efficiency has practical and financial implications such as decreased total operating and recovery room times, decreased cost of medicines, and decreased operating time for the surgeon. Lastly, this technique might also be used for lower extremity surgeries.

CONCLUSIONS: Forearm Bier block is a safe and efficient method for upper extremity surgery. It significantly reduces the risk of complications and increases the efficiency of the surgeon and surgery facility.