Bier Block - This Dog Can Still Hunt

Yak - photo by JoAnn Sturman

Scott Sturman MD

With the advent of ultrasound guided brachial plexus blocks, the indications for Bier Block have waned in recent years.  The technique, however, remains useful for cases lasting between 20 and 60 minutes where MAC anesthesia is inadequate, brachial plexus blocks are impractical, or one wishes to avoid general anesthesia.  The most common problems–a leaking tourniquet, inconsistent analgesia, and tourniquet pain– can be avoided with a few Tricks of the Trade.

Generous IV sedation and prophylactic labetalol given at the first of the case will preempt sudden blood pressure elevations which may cause leaking from an otherwise well functioning tourniquet.

Faster onset and a more reliable analgesia can be obtained by forceful injection of 50 cc 0.5% lidocaine solution.  Placing a finger over a prominent vein and noting its distention insures a “pressurized” block and a well functioning tourniquet.

Tourniquet cycling and propofol-ketamine infusions are useful for dealing with tourniquet pain and extending the time patients can tolerate the tourniquet.