SAQ 452 – Anaesthetics – Bier block for distal radius fracture

Anaesthetics – Bier block for distal radius fracture.

a. Contraindications

• Local anaesthetic allergy.
• Peripheral vascular disease or Raynaud disease.
• Sickle cell disease.
• Local infection or cellulitis.
• Uncooperative patient or refusal of consent.
• Severe hypertension, unstable epilepsy, significant liver disease, AV fistula/lymph node clearance, inability to obtain IV access, open fracture, or child where inappropriate.

b. Drug and dose

• Prilocaine 0.5% at 2.5 mg/kg, approximately 0.5 mL/kg, according to local maximum dose guidance.

c. Steps

• Explain the procedure and obtain consent.
• Use appropriate monitoring, resuscitation equipment and two trained clinicians where possible.
• Confirm correct patient, limb, IV access in the affected limb and absence of contraindications.
• Apply double-cuff tourniquet and exsanguinate/elevate the limb.
• Inflate proximal cuff to at least 100 mmHg above systolic pressure and confirm loss of distal pulse.
• Inject the calculated prilocaine dose slowly via the distal IV cannula.
• Monitor for pain and local anaesthetic systemic toxicity.
• After anaesthesia develops, move to distal cuff if required for comfort.
• Keep the cuff inflated for at least 20 minutes and deflate in a controlled manner while monitoring the patient.