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From: Musab Yahia

> Is the Bier block practical for use in the ED?

--> Very!

And I don't actually like to do it much; some colleagues do more. So I am not trying to "sell" it, but my not using it is NOT because it is impractical! A very good option.

> When used, how long after do you monitor the patient for?

--> Patient may leave as soon as cuff is deflated. No need to monitor after that.

> Would you prefer it in fracture reductions versus if moderate sedation was an option?

--> No, but this is personal preference and I would not claim sedation is BETTER - there is simply more than one way and I prefer sedation. I also do nerve blocks, axillary blocks and haematoma blocks. I do like the latter, especially in adults.

> Other than the potential of lidocaine causing an arrhythmia if improperly done, what complications have you seen from the Bier block?

--> No complications.

Please note that there was a full stop after the "no complications" bit. That's that!

Of course, this may well be because I have not used lidocaine/lignocaine for this since the early 90s. Prilocaine is agent of choice. MUCH less likely to cause arrhythmia or other side effects and I am not aware of any. Reports are that they did not even occur with accidental cuff deflation or even when cuff was not inflated at all.

From: Martin Herman ([log in to unmask])
> Be cautious about the bier blocks bc of the low therapeutic index and risk of cuff failure

--> Not such an issue with Prilocaine.

Use of double-cuff machines should take care of the cuff failure issue.

Ideal machines are those with ACTIVE deflation, i.e. if you pull the cuff tube out of the machine it stays inflated - the machine is required in order to RELEASE the pressure! So no accidental deflation and no need for back-up cuffs, as the 2nd cuff is built in. Not sure one can still purchase a single-cuff version in the UK (nor would anyone want to!).

Also no need for significant starving with Bier's blocks. When they try to compare the incidence of vomits with prilocaine and short vs. long starvation, e.g. 3hrs vs 6hrs, the study suffered from the complete absence of vomits in both groups...

Also, of course, with Bier's block, if there was a vomit, it's NOT in a sedated patient, which is relevant for aspiration.

Good idea to apply topical EMLA/Ametop at site of IV cannula, but local ice application also works.

Hope this helps. Lots of stuff on line for this. 		 	   		   		 	   		  
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