Dear Dr. Al-Yahia and Colleagues,
I am a long time observer, but this is my first post.
I agree with the previous posts that eating prior to reduction wouldn’t
necessarily preclude me from doing a sedation. However, I understand your
predicament as the previous hospital where I worked was quite strict on NPO
I am quite familiar with Bier blocks and helped to institute them in our
tertiary care PED last year (Montreal Children’s Hospital, roughly 80,000
visits per year). Since starting the program we are approaching our first
hundred patients (nothing compared to Melbourne who have been doing them
for decades). I am admittedly biased by our positive experience with Bier
blocks, and would like to weigh in on the discussion.
1. Is the Bier block practical for use in the ED? When used, how long after
do you monitor the patient for?
Yes. It is safe, efficient and family-centered. We monitor for 20 minutes
post procedure, but this is a little arbitrary. This gives us time to get a
confirmatory x-ray and check the cast.
2. Would you prefer it in fracture reductions versus if moderate sedation
was an option?
Personally yes, but it depends on the patient, however this may be a
function of our PED’s limited access to moderate sedation options.
3. Other than the potential of lidocaine causing an arrhythmia if
improperly done, what complications have you seen from the Bier block?
Our personal experience has been very reassuring, but you need the right
safe guards and equipment in place. I would recommend using a Zimmer
automatic tourniquet if you are going to be regularly doing this procedure.
Potential complications can include not only cardiac but also CNS effects
and local pressure effects.
I am happy to speak further off –line if you are interested. Please contact
me via email.
In addition I am interested in collaborating with other institutions that
are doing Bier blocks in the PED on a regular basis. Please contact me if
you are interested.
Adam Bretholz, MD, FRCP
Monteal Children’s Hospital
On Wed, Oct 9, 2013 at 12:29 AM, Musab Yahia <[log in to unmask]> wrote:
> Hi Everyone!
> I wanted to get input from anyone who's had experience using Bier blocks
> for fracture reductions. I've had several cases in the past couple of weeks
> where kids sustained a distal upper extremity fracture (which require
> reduction) and ate something shortly prior to ED arrival. Moderate sedation
> isnt an option and getting into the OR within a reasonable time frame isn't
> 1. Is the Bier block practical for use in the ED? When used, how long
> after do you monitor the patient for?
> 2. Would you prefer it in fracture reductions versus if moderate sedation
> was an option?
> 3. Other than the potential of lidocaine causing an arrhythmia if
> improperly done, what complications have you seen from the Bier block?
> Any input is appreciated.
> Musab Al-Yahia, MD
> Gulf Coast Medical Center Emergency Room
> Panama City, Florida
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
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