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In message <8AFB10D0D3D6D3119C27009027E77D39085739@PWHEXG1>, Robert Anthony COCKS <[log in to unmask]> writes >John > >I'm puzzled by your mention of a high failure rate. I haven't personally >done any Biers since I've been in HK, but when I routinely used the >technique during winter "Colles season" in the UK, I didn't encounter any >which failed to work out of well over 100 done. There were some where I >failed to find a vein to set up the block in the first place, but using >30-50ml of 1% Prilocaine was always reliable once in. Perhaps I was using a >lot.......? I too was puzzled to hear of high failure rate: don't think I've ever had a Bier's (hundreds by now) fail. Suggest you check your data sheet on amount and concentration indicated for Bier's. Max suggested is 40mls of 0.5%. Have to say, I think this may be the drug company being very cautious (assuming you inject the whole lot as iv bolus into systemic circulation?). Remember 1 anaesthetic reg who used your suugested dose of 40mls 1%, never had a problem. As long as you leave the cuff up for >20 mins, should be safe enough, but don't tell the Royal College of Anaesthetists, and don't watch "Paper Mask" too often! Dr G Ray Staff Grade A&E Sussex Reply to [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%