A Modern Approach to the Bier Block Technique
- PDF / 3,682,458 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 18 Downloads / 185 Views
SURGERY
A Modern Approach to the Bier Block Technique Shahram Shawn Yari 1 & Jonas Hafkin 2
&
Jawad Khan 3 & David Netscher 4
Accepted: 10 August 2020 # Springer Nature Switzerland AG 2020
Abstract We describe our preferred technique of administering a Bier block for hand and upper extremity surgery using Lidocaine as the typical local anesthetic. The Bier block, also known as intravenous regional anesthesia (IVRA), can be used for various surgeries on the upper and lower limbs and involves the placement of a double tourniquet around an extremity followed by injection of a local anesthetic into the venous system of that extremity. The traditional Bier block technique offers the advantage of anesthesia in the operative extremity without the need to inject local anesthetic directly into the soft tissue (which tends to distort soft tissue planes and does not wear off as quickly) and without the need for general anesthesia. Our described technique aims to enhance the safety of this method of regional anesthesia and improve patient comfort. We can extend the indications for using a Bier block to include patients with large, short, or conical shaped arms and describe how to protect frail skin and exsanguinate the arm for best surgical outcomes. Keywords Bier block . IVRA . Hand surgery . Lidocaine
Introduction The Bier block, also known as intravenous regional anesthesia (IVRA), was first described by German surgeon August Karl Gustav Bier in 1908. The traditional technique can be used for various surgeries on the upper and lower limbs and involves the This article is part of the Topical Collection on Surgery Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00456-0) contains supplementary material, which is available to authorized users. * Jonas Hafkin [email protected] Shahram Shawn Yari [email protected] Jawad Khan [email protected] David Netscher [email protected] 1
Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
2
CHI Saint Lukes Health Patients Medical Center, Houston, TX, USA
3
Baylor College of Medicine, Houston, TX, USA
4
Plastic and Reconstructive Surgery, Hand and Microsurgery, Baylor College of Medicine, Houston, TX, USA
placement of a double tourniquet around an extremity followed by injection of a local anesthetic into the venous system of that extremity [1–5]. Retrograde injection of intravenous local anesthetic is thought to cause high tissue concentrations of the drug by increasing infiltration and permeation of the drug into the tissue [2, 6]. Since the original description of the technique, modifications have been suggested to improve efficacy, minimize patient discomfort, and to increase the duration of patient tolerance for longer procedures [1, 2, 4]. Different methods of achieving IVRA have been published [1, 2, 4, 8, 10–13]. The advantages of IVRA include the speed of inducing analgesia, decreased operative site bleeding, and ease of performance in most operating rooms with standard equipment [2, 7–9]
Data Loading...
