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Bier’s block

If you have a private operation planned, it may involve an anaesthetic procedure, in this instance a Bier’s block . You may wish to know what this involves.
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.


What is the problem?

You need an operation on your arm, hand or foot. The advantage of a Bier’s block is that you do not need a general anaesthetic. You can stay awake for the operation. The anaesthetist can give a sedative drug to make you feel relaxed and less anxious.


What is a Bier’s block?

A Bier’s block is an injection of local anaesthetic into a vein in your arm or leg. This numbs the nerves that supply that limb. The limb stays numb for 1-2 hours. During this time the operation can be performed on the arm or leg without causing you any pain.


The aims

The aim is to numb your limb, so that you feel no pain during your operation. Your anaesthetist will talk to you before doing the block. S/he will explain whether you will be aware or sedated during the operation.


The benefits

If you have a serious medical condition, such as heart or lung disease, a general anaesthetic may have more risk than normal. Doing the operation with a Bier’s block will be safer. This also means a faster recovery with less sickness after the operation. You may prefer to stay awake during the operation.


Are there any alternatives?

Operations can also be performed under general anaesthetic or by injecting local anaesthetic at the operation site. Operations on the lower limbs can be done using a spinal or epidural injection in the back. The benefits and risks of the different techniques vary depending on the operation and any other medical problems you have. You should discuss this with your anaesthetist.


Who should have it done?

Patients needing surgery on the arm, hand or foot can have a Bier’s block.


Who should not have it done?

If you are unhappy about the procedure for any reason, you should not continue. There are specific medical situations when a Bier’s block should not be done. They are:


  • If you are taking drugs that prevent your blood from clotting, such as Warfarin. If you are on Warfarin, or any other drug that thins the blood, tell your surgeon and your anaesthetist.
  • If you have had a blood clot in a limb before, a Bier’s block may not be suitable.
  • If you have an allergy to local anaesthetics.
  • If it is difficult to find a vein in your arm or leg.
  • For operations longer than one hour or so, a Bier’s block will be not be suitable.
  • Patients with certain illnesses, such as sickle cell disease, lymphoedema and renal dialysis patients, should not have a Bier’s block. A tight band, called a tourniquet, has to be applied to the upper arm for a Bier’s block. This would lead to problems if you suffer from one of these conditions.


Author: Dr Sean White FRCA. Consultant in pain and anaesthesia

© Dumas Ltd 2006

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