Biers Block

Last updated 10.08.12

 

Definition

-  LA technique using large volume LA IV into exsanguinated limb

 

Rationale

-  Minor procedures lasting < 90min

-  Wound repair

-  Reduction of fractures or dislocations

 

Features

-  Double cuff reduces cuff pain

-  Allows changing of cuff pressure during procedure

 

Equipment

-  Cannulation equipment

-  LA: Prilocaine 0.5%

-  Syringe

-  Specialised Biers Cuff (Double)

-  Air source for cuff inflation

-  +/- Webril

 

Cuff

 

Procedure

-  Fast pt 4-6hrs

-  Monitor

-  Continuous ECG & pulse oximetry

-  Periodic BP

-  IV cannula

-  Bilaterally

-  As distal as possible in effected limb

-  Webril around limb to prevent bruising from cuff

-  Exsanguinate limb

-  Elevation

-  Escmarch bandage: distal to proximal

-  Inflate distal cuff

-  Placed on upper arm/leg

-   +/- forearm cuff w lower dose

-  2hrs +/-

-  Systolic BP + 100mgHg

-   300mmHg adults

-   200mmHg children

-  Report when on & off + document

-  Ensure no distal pulses

-  Inject Prilocaine 0.5% 3mg/kg (Max 200mg (40mls)) over 2 min

-  Ensure adequate anaesthesia: 5-20 min

-  Observe for systemic effects

-  Restlessness, dizziness

-  Tinnitus, seizure, muscle excitation

-  Hypotension, bradycardia

-  Inflate proximal cuff

-  Systolic BP + 100mgHg

-   300mmHg adults

-   200mmHg children

-  Deflate distal cuff

-  Remove Esmarch bandage

-  Perform the required procedure

-  If cuff pain

-  Inflate distal cuff

-  Deflate proximal cuff

-  Ensure at not point both cuffs are deflated

-  Deflate cuff no earlier than 30min after Prilocaine injected

-  Deflate & reinflate cycles 30sec/30sec x 1-2

-  Observe for systemic effects for 15min+

 

Diagram

 

Contraindications

-  Unstable epilepsy

-  Uncontrolled HTN

-  Severe liver disease

-  Sickel cell anaemia

-  2nd or 3rd degree heart block

-  PVD

 

Cautions

-  Document/announce clearly when block on & off

-  Must ensure cuff is not deflated prematurely else massive infusion of LA systemically: arythmia, death