Overview of Bier Block
In 1908, a doctor named August Karl Bier wrote about a new method of putting patients to sleep for surgery, which is called anesthesia. His work focused on spinal anesthesia and using tourniquets (tight bands, usually applied to a limb to control bleeding) and local anesthesia (numbing a specific area). Bier’s new method involved draining the blood from an arm or leg and injecting the local anesthetic. However, this way of doing anesthesia wasn’t immediately liked or used widely.
It wasn’t until 1963 when another doctor, Holmes, wrote a paper about this method that it gained popularity. Many people praised this method, also known as intravenous local anesthesia or the Bier Block. Over time, many different ways of using this method have been described, and it has proven to be a great option for numbing patients for certain shorter surgeries.
This method is primarily used for surgeries that target the upper or lower extremities (arms or legs) and that take less than an hour. These surgeries can include relieving carpal tunnel syndrome (a common condition causing pain and numbness in your hand and arm), releasing a condition called Dupuytren’s contracture (a hand deformity that usually develops over years), removing a neuroma (a type of nerve tumor), reducing fractures (putting broken bones back into place), and several other types of surgeries.
Why do People Need Bier Block
The Bier block, also known as IVRA, is a simple and effective way to numb an area of your body (in most cases, your arm or leg) for surgery. This procedure is not only easy to perform but it also doesn’t require a lot of equipment. Instead of putting you under general anesthesia, which means you would be asleep for the surgery, this block allows you to stay awake while not feeling any pain in the area being operated on. It also helps the surgeon by keeping the operation area free of blood.
The IVRA method hasn’t changed significantly since it was first introduced. Here’s what happens during this procedure: A needle is used to place an intravenous line (IV), which is a thin, flexible tube, in the area of your body where the surgery will happen. A band (tourniquet) is then placed above the area to stop blood flow. Then, the team takes steps to remove as much blood as possible from the area being operated on. This process, known as exsanguination, often involves lifting the limb for a few minutes, then wrapping it tightly to squeeze out the blood. Once that’s done, the anesthetic is injected into the IV to numb the area. This has to be done slowly and carefully to avoid the medication leaking out of the limb into the rest of your body.
Shortly after the anesthetic is injected, you might notice that parts of the limb look pale or white—this is because the remaining blood is being pushed toward the skin surface. While the whiteness doesn’t guarantee that the block will work perfectly, it’s generally a good sign that the numbness will be enough for the surgery. Note that the amount of anesthetic used can change depending on which medication is used. Lidocaine is very common, but medications like prilocaine, ropivacaine, and chloroprocaine can also be used. However, bupivacaine is avoided due to the risk of causing heart problems. It’s also important that the medication doesn’t contain any preservatives or epinephrine (a hormone that helps your body respond to stress) because these could cause complications.
Once everything is ready, the surgery can happen. The band that’s stopping the blood flow must stay in place for at least 30 minutes. After the surgery, it’ll be slowly loosened to let the blood flow back in gradually. Research has found many ways to improve this process—for example, some studies have found that placing the tourniquet on the forearm, instead of higher up on the arm, can be just as effective and may even reduce some of the pain and discomfort caused by the tourniquet. Other studies have tried adding medications like opioids (for pain), dexamethasone (an anti-inflammatory), or NSAIDs (another kind of anti-inflammatory) to the anesthetic to improve pain control after the surgery.
Overall, it’s clear that the Bier block or IVRA is a reliable, safe, and effective way to provide anesthesia for certain types of surgeries. Your healthcare team will be able to provide more information about what to expect based on your specific situation.
When a Person Should Avoid Bier Block
There are some situations where a medical procedure cannot be done or isn’t recommended. These situations are known as absolute or relative contraindications:
Absolute contraindications, or solid reasons a procedure can’t be done, include if the patient doesn’t want the procedure, is allergic to local anesthetics (drugs used to numb a specific area), or has certain health problems. These can include poor blood flow to the limb being treated, certain disorders involving blood clots in the veins (like deep vein thrombosis or thrombophlebitis), high blood pressure that isn’t under control, or a wound or significant injury to the limb. The procedure also isn’t performed if there isn’t a way to remove all blood from the limb or if there’s a surgical operation involving the limb.
Relative contraindications, or situations where a procedure might be risky and needs careful consideration, involve if a patient has a hard time cooperating, is overweight that affects the reliability of the blood pressure machine if it is used on large limbs, or has nerve disorders (neuropathies or arrhythmias). Other relative contraindications could be surgical procedures lasting over 2 hours, sickle cell disease (a disease affecting red blood cells), or Paget’s disease (a condition that disrupts the replacement of old bone tissue with new bone tissue).
Possible Complications of Bier Block
The Bier block is a safe technique often used in surgeries. Like every medical procedure, it’s important to be aware of some potential risks even though they are very rare. Investigating cases from 1980-1999, researchers found only three with serious outcomes like death or brain damage linked to this method.
Very rarely, serious side effects may include local anesthetic systemic toxicity (LAST, a reaction to the anesthesia), strange behaviors before a seizure (preictal behavior), actual seizures, and heart attack. Less severe potential risks include potential nerve damage, a condition known as compartment syndrome where pressure builds up inside the muscles, skin discoloration, small purple or red spots on the skin (petechiae), and inflammation in the veins (thrombophlebitis). The most common discomfort you may feel during this procedure is pain because of the cuff used to stop the blood flow (tourniquet).
If you’re experiencing this, the doctor can adjust the cuffs to get you comfortable. If that doesn’t help, they might give you more medicine for sedation or pain relief. As always, remember all medical procedures have potential risks but these are very minimal with a Bier block.
What Else Should I Know About Bier Block?
In conclusion, the Bier block is a safe and cost-effective method of providing numbing relief for small duration surgeries on the arms or legs. This sleek technique does not require much extra equipment and can be performed in many different medical settings. Although the risk of developing a “local anesthetic systemic toxicity (LAST)” – essentially a sugar rush-like side effect of the anesthetic – is very rare, it’s still recommended to have treatment plans ready just in case. There are various additional treatments which can help reduce the discomfort from the procedure, enhance the numbing effect, and aid in reducing pain after the surgery. Among these, ketorolac, a type of pain-relief medication, has shown the most promise in providing relief from post-surgery pain.