Bier's block—an improved technique

Eastwood, DM; Griffiths, Sophie; Jack, J.; Porter, Keith; Watt, James

doi:10.1016/0020-1383(86)90331-1

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…One article was retracted because of fabricated data and 15 full-text articles were assessed. After exclusion of ineligible studies, 3 RCT’s were included in the qualitative and quantitative synthesis [ 7 , 20 , 21 ]. Finally, 4 articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA.…”

Section: Resultsmentioning

confidence: 99%

“…3 . Two studies [ 7 , 20 , 21 ] had a low risk of bias in all domains. Considering the nature of the interventions, blinding of participants was not possible.…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of study design, participants, intervention with choice and dosage of local anesthetic, surgical procedure and tourniquet placement are listed in Table 1 . The oldest study [ 21 ] administered the same doses of LA for both the upper arm and the forearm group. The other two studies [ 7 , 20 ] administered half the dose of LA for forearm IVRA in comparison with upper arm IVRA.…”

Section: Resultsmentioning

confidence: 99%

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The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

et al. 2018

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BackgroundThe main objective of this review is to perform a systematic review and meta-analysis of the existing evidence related to the analgesic efficacy with the use of conventional, upper arm intravenous regional anesthesia (IVRA) as compared to a modified, forearm IVRA in adult patients undergoing procedures on the distal upper extremity.MethodsMEDLINE, EMBASE and CENTRAL (Cochrane) databases were searched for randomized controlled trials published in English, French, Dutch, German or Spanish language. Primary outcomes of interest including description of quality level of anesthesia and onset of sensory block were assessed for this review. Dosage of the local anesthetic, local anesthetic toxicity and need for sedation due to tourniquet pain were considered as secondary outcomes.ResultsOur literature search yielded 3 papers for qualitative synthesis. Four other articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA. Forearm IVRA was found to be as efficient as upper arm IVRA (RR = 0.98 [0.93, 1.05], P = 0.78), but comes with the advantage of a lower need for sedation due to less tourniquet pain.ConclusionOur results demonstrate that forearm IVRA is as effective in providing a surgical block as compared to a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic. No severe complications were associated with the use of a forearm IVRA. Other benefits of the modified technique include a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field.Registration of the systematic reviewA review protocol was published in the PROSPERO register in November 2015 with registration number CRD42015029536.

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Section: Resultsmentioning

confidence: 99%

“…3 . Two studies [ 7 , 20 , 21 ] had a low risk of bias in all domains. Considering the nature of the interventions, blinding of participants was not possible.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

et al. 2018

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“…Eastwood et al demonstrated that the application of a simple Penrose drain used as an adjunct to a pneumatic arm tourniquet increased the speed of the onset of anesthesia (3). This application wais theorized to cause a rapid rise in venous pressure, leading to a widening of the space between the endothelial cells and pericytes, and thus, rapid distribution.…”

Section: Introductionmentioning

confidence: 99%

Simple Arm Tourniquet as an Adjunct to Double-Cuff Tourniquet in Intravenous Regional Anesthesia

et al. 2016

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Background:Intravenous Regional Anesthesia (IVRA) is a well-known technique for producing analgesia during surgical procedures in the extremities. However, the rapid onset of pain following the deflation of a double-cuff tourniquet during IVRA is a serious disadvantage, leading patient suffering.Objectives:The aim of this study was to evaluate the clinical effectiveness of a pneumatic arm tourniquet applied 2 cm above the double-cuff tourniquet in controlling the pain that occurs after its deflation.Patients and Methods:Twenty patients undergoing outpatient hand surgery were operated on under IVRA, using 40 - 50 mL of a solution containing 3 mg/kg of lignocaine. A simple pneumatic tourniquet was applied proximal to the double-cuff tourniquet, 3 min before its deflation, while the procedure was being conducted. The severity of pain on the basis of the Numerical Rating Scale (NRS) was assessed throughout the operation, and continued until an hour after the double-cuff tourniquet was removed.Results:The mean operation time after the deflation of the double-cuff tourniquet was 20.12 ± 6.1 minutes. Moreover, the mean NRS for the post-deflation time was insignificant (NRS = 2), and only one patient during first 20 minutes received opioids.Conclusions:This study showed that a pneumatic arm tourniquet as an adjunct to IVRA provides acceptable analgesia following the deflation of the double- cuff tourniquet for relieving surgical pain.

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“…Eastwood reported quicker effective anaesthesia for manipulation of Colles' fractures when the local anaesthetic was injected distally, but with a second tourniquet just proximal to the fracture [4]. It has been suggested that this represents a direct effect of the local anaesthetic on the nerve endings in the proximity of the injection site.…”

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confidence: 99%

A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m‐labelled BRIDA

et al. 1997

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SummaryIntravenous regional anaesthesia of the upper limb is a widely used technique first described by Bier in 1908. The exact site of action of injected local anaesthetic has not been determined. We have performed intravenous regional anaesthesia on volunteers using prilocaine mixed with technetium 99m-labelled 2,4,6 trimethyl-3-bromo iminodiacetic acid. Two different techniques of intravenous regional anaesthesia (the 'normal' cuff and the intercuff techniques) were combined with gamma camera tracking of the radiolabel to determine the site of local anaesthetic action. The onset of action was similar for both techniques. The local anaesthetic was mainly retained in the antecubital fossa in both techniques but in the 'normal' technique, the local anaesthetic subsequently showed some retrograde spread. This would suggest that the main site of action of local anaesthetic used for intravenous regional anaesthesia is the larger nerves in the vicinity of the antecubital fossa.

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Bier's block—an improved technique

Cited by 10 publications

References 9 publications

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review

Simple Arm Tourniquet as an Adjunct to Double-Cuff Tourniquet in Intravenous Regional Anesthesia

A comparison of intercuff and single cuff techniques of intravenous regional anaesthesia using 0.5% prilocaine mixed with technetium 99m‐labelled BRIDA

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