Intravenous Regional Block
A Bier block
utilizing local anes-thetic solution with or without adjuvants can be used
to interrupt sympathetic innervation to an extremity. A total volume of 50 mL
of 0.5% lidocaine is typically injected, either alone or in combination with
clonidine (150 mcg) and in some cases ketoro-lac (15–30 mg). A tourniquet is
placed proximally on the extremity, which is then elevated and exsan-guinated
using an Esmarch bandage. The tourniquet is inflated to a pressure that is two
times the systolic blood pressure, the Esmarch bandage is removed, and the limb
is checked to be certain the pulse is absent and there is no evidence of blood
flow. The solution is then injected and usually left in place for at least 30
min, after which the tourniquet is released incrementally and the patient is
observed for any signs or symptoms of local anesthetic toxic-ity. Premature
release of the tourniquet may result in seizure, hypotension, arrhythmia,
edema, diarrhea, and nausea. Intravenous regional sympathetic block is a safe
alternative to standard sympathetic blocks in patients with hemostatic defects.
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