Ray
I have refined my Biers Block technique over the years. I started with 0.5%
lignocaine in the Republic of Ireland almost 10 years ago, no ill effects
with that. I moved to 0.5% prilocaine in England, again no ill effects and
brilliant surgical anaesthesia with both methods - you can really
manipulate, a la Charnley, with this type of anaesthesia; none of this
patient grimacing "it's not that bad doctor" like one sees with haematoma
blocks!
I use a single cuff technique routinely as I aim for cuff deflation after
only 15 minutes. I've never had post-deflation toxicity with this timing.
(I've only seen toxicity with "haematoma" block). OK I miss the chance to
see the x-ray and remanipulate, but the anaesthesia with Bier's is so good,
it allows aggressive manipulation at the first attempt. So if I can't get a
good reduction first time round, I figure I'm not going to do any better
second time. In this event, I'm afraid it's off to the orthopods for GA
manipulation under image intensifier.
Adrian Fogarty
A&E Consultant
Royal Free Hospital
----- Original Message -----
From: mcglonerg <[log in to unmask]>
To: Gautam <[log in to unmask]>
Cc: Acad-ae-med <[log in to unmask]>
Sent: Wednesday, July 12, 2000 9:42 PM
Subject: Re: Bier's Block
> 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
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