From the Research
Bier's block should be performed using a forearm Bier block technique, which involves exsanguination of the forearm, inflation of a pneumatic tourniquet placed distal to the elbow joint, and injection of 25 milliliter of 0.5% lidocaine intravenously, as this technique has been shown to be safe and efficient with minimal risk of complications 1.
Key Steps
- Elevate the limb to be anesthetized and apply an Esmarch bandage to exsanguinate it
- Inflate a pneumatic tourniquet to 100 mmHg above systolic blood pressure, placed distal to the elbow joint
- Inject 25 milliliter of 0.5% lidocaine (without epinephrine) into a previously placed IV cannula in the affected limb, slowly over 90 seconds
- Ensure the tourniquet remains inflated for a minimum of 20 minutes to prevent systemic local anesthetic toxicity
- For procedures lasting longer than 60-90 minutes, consider inflating the distal tourniquet over anesthetized skin and deflating the proximal one to reduce tourniquet pain
- When deflating the tourniquet, use a cyclic deflation technique to minimize the risk of local anesthetic toxicity
Benefits
- Reduced risk of complications, such as cardiac and neurologic toxicity, compared to the standard upper arm technique 1
- Shorter tourniquet time, minimizing tourniquet pain and risk of ischemic problems
- Increased efficiency, with decreased total operating and recovery room times, and decreased cost of medicines
Important Considerations
- The dosage of lidocaine needed for the forearm Bier block is significantly reduced, minimizing the potential for complications 1
- The technique has been shown to be effective for upper extremity surgery, with no intraoperative or postoperative complications reported in a study of 105 patients 1
- The forearm Bier block technique may also be used for lower extremity surgeries, although further studies are needed to confirm its safety and efficacy in this context.