Efficacy of a Modified Bier's Block in Patients Undergoing Upper Limb Bone Surgery


Aliakbar Jafarian 2 , Valiollah Hassani 2 , Fatemeh Jesmi 2 , * , Koosha Ramezani 3 , Fereydoun Javaheri 1 , Hooman Shariatzadeh 1

2 Minimally Invasive Surgery Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Shahid Beheshti University of Medical Sciences, Tehran Iran

1 Department of Anesthesiology, Shafa-Yahyaeian Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran

How to Cite: Jafarian A, Hassani V, Jesmi F, Ramezani K, Javaheri F, et al. Efficacy of a Modified Bier's Block in Patients Undergoing Upper Limb Bone Surgery, Anesth Pain Med. 2015 ; 5(1):22007. doi: 10.5812/aapm.22007.


Anesthesiology and Pain Medicine: 5 (1); 22007
Published Online: February 27, 2015
Article Type: Research Article
Received: July 12, 2014
Accepted: September 30, 2014


Background: Intravenous regional block, called the Bier's block, refers to an analgesic technique applied for soft tissue surgeries and closed bone manipulations of the limbs. There are a number of complications in traditional method of block, including pain in tourniquet site, immediate return of pain after tourniquet deflation, wound hemostasis and some others.

Objectives: The aim of this study was to assess the outcomes and complications of our new method of blockage.

Patients and Methods: In this experimental study, twenty-five patients undergoing hand surgery were prospectively studied. Induced anesthesia was a modification of the Bier's block with two concurrent changes including insertion of the intravenous cannula at the antecubital region rather than distal and the proximal anesthetic direction by an elastic band wrapped tightly around the proximal forearm distal to the cannulation site. The pain relief was measured by the verbal descriptive scale at intervals after block, during the operation, after deflation of the tourniquet and one hour after the operation.

Results: This study showed the presence of analgesia at surgical and tourniquet sites during the operation in 96% of patients, as well as considerable pain relief at surgical site during one hour after deflation of the tourniquet.

Conclusions: The study indicated advantages of this modified Bier's block compared to the traditional one including ability to perform surgery on upper limb bones and considerable pain relief at surgical and tourniquet sites during the operation until one hour thereafter.

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