The Role of Bier's Block In Upper Limb Surgery

Abstract

Objective: To assess the efficacy of the Bier's block or intravenous regional anesthesia (IVRA) in upper limb orthopedic surgical procedures. Methods: Prospective descriptive study was conducted at the Department of Orthopedic Surgery, Peoples University of Medical & Health Sciences (PUMHS) Nawabshah from January 2016 to December 2016, 50 patients above the age of 15 years irrespective of sex were included in the study. The demographic and clinical data was collected on a proforma. Single cuff pneumatic tourniquet was used, after exsanguination tourniquet was applied and the cuff was inflated to 100-150 mmHg above the systolic BP, check for the absence of radial pulse. 0.5% xylocaine, prepared according to patient's weight, after 5 minutes another tourniquet was applied distal to the first one and proximal was released. After completion of procedure but not before 30 minutes, tourniquet was gradually released. The efficacy of Bier's block anaesthesia was measured in terms of age, sex, duration of surgical procedure, duration of Bier's block and post-operative complications. Results: A total of 50 patients were analyzed, including 36 (74%) males and 13 (26%) females, ranging between 15 to 65 years with an average of 30 years. Duration of Bier's block ranged from 30-60 minutes (average 45 minutes), and the duration of Surgical procedure varied from 20-60 minutes (average 40 minutes). The Bier's block (IVRA) was very well tolerated in majority of patients. Preoperative side effects included, transient rise of pulse in 6(12%) patients, a minor rise of systolic blood pressure was noticed in 3(6%) patients, tourniquet pain for initial 10 minutes in 4(8%) patients. Transient tourniquet palsy was detected in one case which recovered in 8 weeks, none of the patients developed systemic side effects or compartment syndrome; none required discontinuation of procedure or change over to another form of anaesthesia. Conclusion: Bier's block was found a safe, effective, economical, easy and reliable method of anesthesia and should be used more frequently.