Has anyone else here heard of the BIVRA? This is a technique I worked with John
Hannington-Kiff (of guanethidine block fame) on about 15 years ago. It is a low-volume
version of the Bier's Block and may be a useful answer. It is an isolated segment technique.
You need TWO tourniquet sets.
1. Exsanguinate the arm by your usual method.
2. Fit one tourniquet in the usual way, and the other over the bulk of muscle bellies below the
radial head. Inflate both (top first) to 5 bar.
3. Insert a cannula at the elbow. We used Y-cans, but they have fallen out of fashion a bit.
The nervous may wish to insert a cannula in the opposite side.
4. Inject in exactly the same way as you would for a Bier's block and observe that the local is
now trapped between the two cuffs at the elbow. What is v useful is that you only need half
the volume.
5. Wait - maybe a little longer than with a normal Bier's, but certainly not more than 5 minutes
or so.
6. While waiting observe the perfect operating conditions in the hand - we used to use this
extensively for carpal tunnels, explorations and so on that simply can't be done under a normal
Bier's as the hand is too soggy to work on properly and oozes impossibly.
7. When firm tapping over the median nerve is painless perform your manipulation.
8. Change the top cuff over onto the numb bit if that is your normal practice.
9. Release both cuffs as you normally would, checking for return of circulation as usual.
Viola!
Best wishes,
Rowley Cottingham
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