Bier's block
| Not too commonly used in the UK...?? | |
|---|---|
| Indication | Distal forearm fracture manipulation |
| Contraindication | Children, hypertension, high BMI... |
| Kit | 0.5% or 1% prilocaine without preservative (if only 1% available, dilute down 1:1 with 0.9% saline) No preparation with adrenaline Max safe dose: 3mg/kg |
| Technique/landmark | - 22G cannula on anaesthetised side → slow injection and wait 13 min for effect - Double cuff tourniquet - Inflate the proximal cuff to 100mmHg above the systolic BP or up to a maximum of 300mmHg - min 20 min, max 45 min |
| Ongoing management | |
| Complications | Local anaesthetic toxicity Methaemoglobinaemia |
sources/links
Prilocaine - preferred for Bier's block (as per RCEM - https://rcem.ac.uk/wp-content/uploads/2024/04/Intravenous_Regional_Anaesthesia_for_Distal_Forearm_Fractures_Biers_Block_v1.pdf)