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14 Cards in this Set
- Front
- Back
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IV Regional or Bier Block Indications?
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Surgery on forearm, wrist, hand and fingers
- Best suited for short procedures (45-60 min) - If needed for more than one hour, tourniquet pain problematic |
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Can a Bier block be done on the leg?
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Yes,
- Leg requires larger volume - Success reported especially if calf tourniquet and foot surgery |
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Contraindications of IV regional anesthesia are?
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Essentially contraindications to tourniquet application
Sickle cell disease Infection Ischemic vascular disease Pain Traumatic lacerations |
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How does IV Regional anesthesia work?
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Peripheral nerve endings of extremities nourished by small blood vessels.
Injection of local into venous system → diffusion of local into nerve endings → anesthesia. Works as long as concentration of local in venous system remains high. Exsanguination of extremity necessary to prevent dilution of local. Results in anesthesia of entire extremity below level of tourniquet. Duration of anesthesia & analgesia limited by tourniquet time. |
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What equiptment is needed for a Bier block?
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- 20 or 22-gauge IV catheter, smaller gauge IV catheter prevents oozing after removal
- Flexible extension tubing - 5" Esmarch bandage - Double cuff tourniquet - 20 mL syringes with local anesthetic - Double-cuff tourniquet with in-line valves - Pressure source for tourniquet - Check for leak before beginning block |
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How do you prepare for a Bier block (begining to touniquet inflation)?
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- Place 20-22 G IV in affected arm.
- Elevate arm for 1-2 min to allow passive return of blood. - Place “double cuff” tourniquet on proximal arm of extremity to be blocked - Soft wrapping (Webril) of arm before applying tourniquet will decrease pinching of unprotected skin - apply tourniquet (don't inflate yet) - Wrap 5” Esmarch from fingertips to distal cuff - After Esmarch is applied, inflate cuffs to pressure of 100 mm Hg above systolic or some say 300 mm Hg if double cuff system used - Inflate the distal cuff - Inflate the proximal cuff |
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How do you perform a Bier block (from tourniquet up to end)?
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- Unwrap Esmarch
- Check for color and arterial occlusion (absence of the radial pulse) - Inadequate occlusion of arterial blood flow by tourniquets → venostasis and venous engorgement of extremity - Lower arm and slowly (5-10 sec-5 min) - Inject local thru IV cath on hand - Onset of anesthesia within 5 minutes - Patient will typically report "pins and needles" in extremity - Sedation good idea after block - Remove IV - Tourniquet must stay inflated for at least 20min. |
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What is the procedure for tourniquet release at the end of surgery?
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Staged deflation
Deflate and inflate again rapidly at least 2-3 times to allow gradual “wash out” of local May alternatively deflate cuff for 10 seconds and reinflate for 1 minute before the final release |
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S/S local toxicity
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Ringing in ears
Lightheadedness Numbness around mouth Slurred speech Confusion Restlessness Seizures |
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Which locals can you use for Bier blocks and what's the half-life?
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- 40-50 mL of 0.5% lidocaine, or
- 12-15 mL of 2% lidocaine - Half-life 1-2 hours |
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What are the most important steps to ensure high success rate of a Bier Block?
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- Proper application of Esmarch
- Completeness of exsanguination |
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Local anesthetic levels peak about ___ minutes after tourniquet deflation.
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2-5 minutes
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How do you prevent hematomas w/bier block?
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- Use small gauge IV catheter
- Apply firm pressure on puncture site for 2-3 minutes if IV attempt unsuccessful |
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How do you prevent engorgement of extremity with bier block?
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- Ensure that tourniquet is functional and that arterial pulse is absent
- May be more common in patients with arteriosclerosis |
