The bad press for Bier's Block relates to when Bupivacaine was used... over
20 years ago now. Prilocaine is very safe. It has been an SHO procedure with
nurse in Lancaster since 1990. Axillary blocks are very good, but there is a
definite learning curve which makes it unsuitable for SHOs... I think.
Regarding the need for muscle relaxation in Bier's block, that is usually
not needed. But if you have a young patient with an overlapping fracture
then you could use Atracurium 2 mg mixed in the total volume injected. See
paper below. I was the volunteer who had 4 mg and got transient blurred
vision when the cuff was released! So not a procedure for SHOs because if
they got the dose wrong there would be problems!!
Ray McGlone
A&E Lancaster
Authors
McGlone R. Heyes F. Harris P.
Institution
General Infirmary, Leeds, England.
Title
The use of muscle relaxant to supplement local anaesthetics for Bier's
blocks.
Source
Archives of Emergency Medicine. 5(2):79-85, 1988 Jun.
Abstract
In searching for the 'ideal' muscle relaxant for use with intravenous
regional anaesthesia, muscle relaxation was assessed with and without the
addition of Atracurium to Bier's Block in four volunteers. This was followed
by a clinical study of 36 patients with wrist fractures to confirm the
drug's safety and examine the possible clinical advantages of using a muscle
relaxant. The addition of 2 mg of Atracurium to the Bier's Block improved
the ease of reduction (P less than 0.025) and the quality of analgesia (P
less than 0.05) (Mann-Whitney U test). The authors conclude that the
addition of Atracurium to a Bier's Block is useful in selected patients with
a wrist fracture
----- Original Message -----
From: "Stephen Hughes" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, September 29, 2002 4:48 PM
Subject: Re: Bier's Block
> In message <002901c267c5$dbbead80$5719e150@DADS>, Ray McGlone
> <[log in to unmask]> writes
> >No it is evidence based.....................
> >
> It certainly is, and that seems to be a good paper. Not that you can
> blind this sort ofwork or even randomise it properly.
>
> I think haematoma blocks should have one purpose only and that is to top
> up an axillary block that hasn't done quite the trick. Is there anyone
> out there who does these regularly? I am tyring to get a series
> together.
>
> As for bier's blocks, I have never seen one because of the mythology
> surrounding them and the lack of prilocaine. Would you believe that?
>
> I have just submitted some of my results as part of my CTR for the exam.
>
> For those interested....
>
> Bowden C.A. Mackay D.F. Axillary brachial plexus block- an underused
> technique in the accident and emergency department.
> J. Accident Emerg Med 1997; 14: 226-229
>
> I use this technique all the time and the long duration of analgesia
> seems popular, but more work is needed to quantify this. I also reckon I
> get better quality of reduction (because the patient is unable to
> fight!)
>
> Presumably the past president of the RCP wishes us to stop us doing all
> this and have us all as a clerking service for the on call physicians.
> --
> Stephen Hughes Bonesetter extaordinaire, 'Arlow.
>
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