I've found two further papers comparing 0.5% and 1% Prilocaine for Bier's
block.
1) Prien et al. Intravenous regional anaesthesia of the arm and foot using
0.5%, 0.75% and 1% Prilocaine. Anasth Intensivther Notfallmed 1990 Feb;25
(1):59-63
The abstract is in English, 7 patients getting 40ml 1% Prilocaine had signs
of local anaesthetic toxicity when the cuff was deflated, whereas there were
no signs of this in the other 2 groups. I've got one of my German Medical
Students to try and get the original paper with translation!
2) Valli et al. Intravenous regional anaesthesia below the knee. A cross
over study with Prilocaine in volunteers. Anaesthesia 1986 Dec;41:(12)
1196-201
Prilocaine 40ml 0.5%, 20ml 1% and 40ml 1% were used. 5 of the six volunteers
getting 40ml 1% had signs of toxicity when the cuff was deflated. The 20ml
Prilocaine 1% gave inferior motor blockade.
One suggestion to the problem is to put a tourniquet over the forearm so
that a smaller volume of Prilocaine can be used. If this was used there
would be little point in using a double cuff for the patient's comfort.
After my own experience having a single cuff Bier's block (Prilocaine with
Atracurium) in Derby I've always used a double cuff and rotated the cuffs.
We get an X ray whilst the cuff is inflated so that the SHOs get the chance
of remanipulating the wrist if necessary.
The onset of anaesthesia should be slightly quicker using Prilocaine 1%
compared to Prilocaine 0.5%. (7.5 min versus 10 min).
At the moment I'm sitting on a year's supply of Prilocaine 0.5%! I think 20
ml Prilocaine 1% followed by 20 Normal Saline will work but it needs a
proper study.
Regards
Ray McGlone
----- Original Message -----
From: Gautam <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 11, 2000 10:11 PM
Subject: Re: Bier's Block
> In message <001401bfe9cc$f12383e0$af867d3e@d3u8f0>, mcglonerg <mcglonerg
> @netscapeonline.co.uk> writes
> >What do the UK A&E Consultants intend to do once the Prilocaine 0.5% runs
out?
>
> We've already run out of 0.5%. We use 20 mls of 1%, neat, for the
> average-sized punter. Our anaesthetic dept have sent round a circular
> suggesting up to 40mls 1% (400mg, >5mg / Kg for your standard 75Kg pt).
> This seems a little OTT to us lowly A&E bods. I've done several Bier's
> with 1%, not just since the demise of 0.5%. Never had a side-effect or a
> failure, but just occasionally need to top up 20mls standard volume with
> 5-10mls extra if slow onset. We tend to put an extra "venous" pressure
> tourniquet (like for normal phlebotomy) just above the # site for the
> 1st few minutes after injection (distally). The idea is to keep the ant-
> pain medicine concentrated in the # site initially. In theory this gives
> a combination haematoma block and (once vebous tourniquet released) a
> IVRA block too. No evidence, except that I've never seen a Bier's fail
> in this dept in 8 years (famous last words).
>
> ps: we are arranging with a local hospital pharmacy dept to mix up our
> own regional supply of 0.5% from 1%, presumably with the pH / tonicity
> safeguards suggested.
>
>
> Dr G Ray
> Staff Grade
> A&E
> Sussex
> Reply to [log in to unmask]
>
>
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