Bier's block-an improved technique - Science Direct
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Bier's block-an improved technique - Science Direct
known as Bier's block is presented. This was applied to patients with Colles' fractures. In a controlled trial the tech- nique produced anaesthesia more quickly ...
Injury(1986) 17,187-188
Printedin GreatBritain
Bier’s block-an
187
improved technique
D. Eastwood, S. Griffiths, J. Jack, K. Porter and J. Watt General Hospital, Birmingham Summary A simple modification
to the method of regional anaesthesia known as Bier’s block is presented. This was applied to patients with Colles’ fractures. In a controlled trial the technique produced anaesthesia more quickly than the other method.
INTRODUCTION INTRAVENOUSregional
anaesthesia based on the technique introduced by Bier (1908, 1910) and subject to modification has been recommended as an alternative
to general anaesthesia for operations on the limbs (Rousso et al., 1979; Ware, 1979; Charn et al., 1981), including its use shortly after injury. It is particularly appropriate in the elderly and in less fit patients, in whom general anaesthesia causes greater morbidity and mortality. It has been shown that prilocaine has advantages over other local anaesthetics in that it is safer and potentially less toxic (Wildsmith et al., 1979, 1980; Wildsmith, 1981). A simple modification to the technique enhances the speed of onset of anaesthesia.
In group B a rubber venepuncture tourniquet was applied firmly round the arm immediately proximal to the fracture site before the injection of the prilocaine. The procedure was then continued as in group A. The venepuncture tourniquet was removed before the plaster back slab was applied and the distal of the two upper arm tourniquets was inflated after the application. This allowed the upper cuff to be deflated, leaving the patient more comfortable during the check radiograph. RESULTS Clinical anaesthesia was achieved in an average of 8 minutes in group A (range 4-15 minutes), compared with an average time of 3 minutes 50 seconds in group B (range l-8 minutes) (Figs. 1 and 2). The application of the Mann-Whitney U test shows this result to be significant (P
