Mini-Dose Bier Block Intravenous Regional Anesthesia in the Emergency Department Treatment of Pediatric Upper-Extremity Injuries

Background: Bier blocks, or intravenous regional anesthesia (IVRA), are a method of anesthesia for upper extremity surgeries. This study reports our experience with tourniquet deflation prior to 20 minutes with upper extremity IVRA. Methods: This study was designed as a retrospective cohort analysis. Records, including intraoperative and immediate postoperative anesthesia notes, of 430 patients who underwent IVRA with an upper extremity Bier block and a corresponding tourniquet time of less than 20 minutes were reviewed. Patient demographics, procedure(s) performed, American Society of Anesthesiologists scores, volume of lidocaine used in Bier block, tourniquet time, and any complications were recorded. Results: This cohort consisted of 127 males and 303 females. The 3 most common procedures performed were carpal tunnel release (315), trigger finger release (47), and excision of masses (34). The average tourniquet time for this cohort was 16 minutes (range, 9-19 minutes), and the average volume of lidocaine (0.5% plain) injected was 44 mL (range, 30-70 mL). A tourniquet time of 17 minutes or less was observed in 339 patients, and 170 patients had tourniquet times of 15 minutes or less. Five complications were recorded: intraoperative vomiting, mild postoperative nausea/vomiting, severe postoperative nausea and vomiting, and transient postoperative hypotension that responded to a fluid bolus. Conclusions: No major complications were observed in our cohort of upper extremity IVRA and tourniquet times of less than 20 minutes. Several variables play a role in the safety of upper extremity IVRA.

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Safety and effectiveness of intravenous regional anesthesia (Bier block) for outpatient management of forearm trauma

CJEM ◽

10.1017/s1481803500013786 ◽

2006 ◽

Vol 8 (04) ◽

pp. 247-250 ◽

Cited By ~ 13

Author(s):

Bruce Mohr

Keyword(s):

Primary Care ◽

Adverse Events ◽

Regional Anesthesia ◽

Primary Care Physicians ◽

Reliable Technique ◽

Intravenous Regional Anesthesia ◽

Common Diagnosis ◽

Extremity Injuries ◽

Bier Block ◽

Forearm Injuries

ABSTRACT Objective: To assess the safety and effectiveness of intravenous regional anesthesia (Bier block) in the management of forearm injuries (i.e., forearm, wrist or hand) by primary care physicians at a diagnostic and treatment facility. Methods: A retrospective review was conducted of all patients at a single centre who underwent a Bier block for forearm injuries between September 2000 and March 2005. Results: 1816 Bier blocks were performed on 1804 patients (64% male) during the study period. Patient age ranged from 4–70 (mean 25) years. Wrist fractures requiring reduction were the most common diagnosis. Adverse events were recorded in 9 cases (0.50%, 95% confidence interval 0.23%–0.94%): 1 case of medication error (0.06%); 3 of improper cuff inflation (0.17%); and 5 of inadequate analgesia (0.28%). None of the adverse events resulted in failure to complete the procedure or in serious morbidity or mortality. Conclusion: Bier block anesthesia is a safe, effective and reliable technique in an outpatient primary care setting. This technique is a useful modality for physicians who manage acute upper-extremity injuries.

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