frequent procedures
 

BIER BLOCK
The Bier block procedure is a procedure that is used in the upper or lower extremities for treatment of complex regional pain syndrome (CRPS) or sympathetic maintained pain. This method of treatment involves the use of a dual inflatable sphygmomanometer device similar to what is used in taking blood pressure, the only difference being that there are two inflatable units that are operated independent of once another during the inflation and deflation process. In a patient with, for instance, right upper extremity sympathetic maintained pain or RSD, the dual cuff is applied to the proximal arm after the upper extremity being treated has been exsanguinated of all possible blood through application of an elastic bandage that starts to get wrapped from the fingers and then goes proximally to the level where the tourniquet or dual cuff is applied, and then inflated in both units.

Following this, an already established IV access on the dorsum of the hand is then used to fill the patient’s venous blood channels in the upper extremity concerned with local anesthetic, for instance, 1% lidocaine and bretylium combination solution and allowed to stay in the patient for the next several minutes after which the cuff is then deflated one unit after another, and slowly, to avoid a sudden rush of the local anesthetic injected into the entire circulation, resulting in severe toxicity when both cuffs are eventually released. The patient is usually monitored closely during and after inflation and deflation of the dual cuff unit.

This process capitalizes the effect of the local anesthetic making close contact with the C fibers which carry the autonomic nerves through which the process of complex regional pain syndrome or RSD, reflex sympathetic dystrophy is mediated since these C fibers are in close proximity to the venous circulation in these patients. It allows the local anesthetic and bretylium to be able to block the meshwork of autonomic nerves that mediate the sympathetic maintained pain. Bier block is done in series to achieve eventual resolution of this problem (CRPS). This can frequently successfully treat Stage I RSD or CRPS mediated pain in these patients.

Complications: As stated above, the most evident complication would be the sudden increase in the level of local anesthetic in the blood stream if there is an accidental or inappropriate release of the tourniquet effect of the dual cuff that is applied in the proximal portion of the extremity concerned, resulting in arrhythmias, sedation, convulsion, or cardiovascular collapse.

Contraindications: Patients who have borderline or significantly impaired cardiac outputs, or predisposition to arrhythmias or on certain medications should not undergo this procedure.

Sedation: Sedation is not required, and is actually contraindicated in this procedure.

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