ANAESTHETICS AND AIRWAY
BIERS BLOCK
PromptContraindications to biers block
ResponseLocal anaesthetic allergy
Open fracture
Sickle cell disease
Severe hypertension (SBP>180)
Methaemoglobinaemia
Cuff won’t reliably fit (Child, morbid obesity)
Uncooperative patient
Lymphoedema, reynauds, peripheral vascular disease
Dialysis fistula
Open fracture
Sickle cell disease
Severe hypertension (SBP>180)
Methaemoglobinaemia
Cuff won’t reliably fit (Child, morbid obesity)
Uncooperative patient
Lymphoedema, reynauds, peripheral vascular disease
Dialysis fistula
PromptSafety measures to consider in Biers Block
ResponseContralateral IV access in case of rescue meds, analgesia
3 lead cardiac monitoring - ? arrhythmia as sign of LA toxicity
Double cuff pneumatic tourniquet - allows for single cuff failure without systemic LA exposure (not actually designed for this though!)
LA dosing guided by toxicity limits - systemic leak less likely to produce toxicity
Pulse check once cuff inflated to ensure efficacy
Perform in resus room with dedicated nursing staff in case of complications
3 lead cardiac monitoring - ? arrhythmia as sign of LA toxicity
Double cuff pneumatic tourniquet - allows for single cuff failure without systemic LA exposure (not actually designed for this though!)
LA dosing guided by toxicity limits - systemic leak less likely to produce toxicity
Pulse check once cuff inflated to ensure efficacy
Perform in resus room with dedicated nursing staff in case of complications
PromptBiers block - procedure
ResponseConsent
Preparation - cardiac monitor, IV access x 2 (one each arm - below fracture)
Cuff able to inflate >100 above systolic
LA - prilocaine 2.5mg/kg (Bupivacaine = bad)
Perform procedure (manipulate fracture and apply plaster)
Cuff to stay up at least 30 minutes
Deflate cuff and observe closely for 15 mins for toxicity
Preparation - cardiac monitor, IV access x 2 (one each arm - below fracture)
Cuff able to inflate >100 above systolic
LA - prilocaine 2.5mg/kg (Bupivacaine = bad)
Perform procedure (manipulate fracture and apply plaster)
Cuff to stay up at least 30 minutes
Deflate cuff and observe closely for 15 mins for toxicity
PromptSeizure post biers block
ResponseMidazolam 5mg IV
Sodium bicarbonate - 100 mmol IV - for sodium channel blockade
IV crystalloid 20 mL/kg +/- inotropic support. Aim SBP >90
IV intralipid
Sodium bicarbonate - 100 mmol IV - for sodium channel blockade
IV crystalloid 20 mL/kg +/- inotropic support. Aim SBP >90
IV intralipid