Intravenous Regional Anesthesia (Bier Block): Henry Hu, MD

Summary

Dr. Henry Wu, Director of Anesthesia at San Francisco City Center, demonstrates the 'Bier Block' technique, a regional anesthesia method used for upper extremity surgeries below the elbow. Key points include the use of a double tourniquet, blood exaggeration, and injecting preservative-free lidocaine. The video emphasizes patient selection, proper tourniquet inflation, and timing for optimal anesthesia without local toxicity. Bier Block is presented as a simple, effective, and reliable anesthesia option for suitable patients.

Takeaways

• 💉 Dr. Henry Wu explains the procedure for performing a Bier block, a regional anesthesia technique used for upper extremity surgeries below the elbow.
• 🔧 The Bier block is suitable for short procedures like carpal tunnel release.
• 🔄 The process involves applying a double tourniquet to the arm to exsanguinate blood from the area.
• 💉 A 22-gauge IV with extension tubing is used to inject 0.5% preservative-free lidocaine into the limb.
• ⏱️ The tourniquet can typically be tolerated for 20-30 minutes, after which the distal tourniquet may be inflated if more time is needed.
• 🔒 It's crucial to maintain the tourniquet for at least 20-25 minutes, even if the surgery finishes early, to avoid systemic lidocaine toxicity.
• ⚠️ Careful patient selection is important; the Bier block may not be suitable for patients with obesity or high blood pressure.
• 🩸 Proper exsanguination is essential to prevent dilution of the anesthetic, which can reduce its effectiveness.
• 📏 The tourniquet pressure should be set 100 mmHg above the patient's systolic blood pressure.
• 🚨 The Bier block is a simple, effective, and reliable anesthesia technique when used in the right patient.

Q & A

What is the purpose of a Bier block?

A Bier block is a regional anesthesia technique used for short surgical procedures on the upper extremity below the elbow, such as carpal tunnel release.

How long has the Bier block been used in medical practice?

The Bier block has been used for more than 100 years.

In which settings is the Bier block widely used?

The Bier block is widely used in emergency departments and perioperative surgical settings.

What is the first step in performing a Bier block?

The first step is to put a double tourniquet on the patient's arm and ensure it is tight, allowing only two fingers to fit inside.

How can you verify that the tourniquet is properly placed?

You can verify the tourniquet placement by inflating it and checking if the radial pulse disappears.

What is used to exsanguinate the blood from the patient's arm?

An Esmarch bandage is used to exsanguinate the blood from the patient's arm, starting from the distal end (fingers) and wrapping upwards.

What type and concentration of local anesthetic is typically injected in a Bier block?

Half percent lidocaine preservative-free is typically injected in a Bier block.

What is the total volume of lidocaine injected if the tourniquet is placed on the upper arm?

50 cc of half percent lidocaine is injected if the tourniquet is placed on the upper arm.

How should the tourniquet be managed if the procedure lasts longer than 30 minutes?

If the procedure lasts longer than 30 minutes, the distal tourniquet should be inflated, and the proximal tourniquet released to extend the anesthesia effect for another 30 minutes.

What are two critical points for successfully performing a Bier block?

Two critical points are: inflating the tourniquet to 250 mmHg or 100 mmHg higher than the patient's systolic blood pressure, and not releasing the tourniquet if the surgery is shorter than 20 minutes to avoid local anesthetic toxicity.

Why is it important to keep the tourniquet inflated for at least 20-25 minutes even if the surgery finishes quickly?

It is important to keep the tourniquet inflated for at least 20-25 minutes to prevent the rapid release of lidocaine into the body, which could cause local anesthetic toxicity.

What patient conditions may contraindicate the use of a Bier block?

Morbid obesity, difficulty placing the tourniquet, and high blood pressure (e.g., starting blood pressure of 180 mmHg) may contraindicate the use of a Bier block.