----- Original Message -----
From: Watson, David <[log in to unmask]>
To: 'acad ae med' <[log in to unmask]>
Sent: Tuesday, April 04, 2000 5:43 PM
Subject: Lignocain in Bier's block
> For some reason I had been removed fron acad ae med and so I have missed
the
> threads over the past few months. I apologise for duplication if this
topic
> has already been discussed.
>
> Do people use lignocain rather than prilocain (now that supplies are
> dwindling) in Bier's block? I understand it is common practice in
Australia.
>
> If this is a repeat mail then private e-mail to me at:
> [log in to unmask] is fine.
>
> Ta
>
> Dpw
>
Is the supply of prilocaine dwindling? I can't say I'd noticed.
As I understand it the side effect profile of lignocaine in Bier's Block is
considerably less favourable than that for prilocaine, particularly with
regards to possible CNS effects (fitting, etc.).
Clearly anything is better than bupivicaine, famous for its resistant
ventricular arrhythmias and which was responsible for giving Bier's Blocks
such a bad name in the first place (anybody remember "Paper Mask").
Unfortunately the technique is still suffering as a result of this, and
judging from recent postings to this list is not used as often as it might
be.
Personally I think that prilocaine is an excellent choice in Bier's Block,
because although it has the theoretical side effects of all amide local
anaesthetics it is also the most rapidly metabolised and generally regarded
as the safest. The only problem of note is methaemoglobinaemia with doses
above 600mg. I have a feeling that you could inadvertently inject the
prilocaine for a Bier's Block with the cuff down and get away with it,
though must add that I have no desire to test this theory!
Jonathan Benger.
SpR, Bristol.
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