The “mini-bier's block”: A new technique for prevention of tourniquet pain during axillary brachial plexus anaesthesia

• Published in: Journal of hand surgery, British volume Vol. 19; no. 3; pp. 347 - 349
• Main Authors: James, N.K., Khoo, C.T.K., Fell, R.H.
• Format: Journal Article
• Language: English
• Published: London, England Elsevier Ltd 01.06.1994; SAGE Publications; Churchill Livingstone
• Subjects: Adolescent; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Axilla - innervation; Axillary Artery; Biological and medical sciences; Brachial Plexus; Bupivacaine - administration & dosage; Elbow - blood supply; Female; Humans; Lidocaine - administration & dosage; Local anesthesia. Pain (treatment); Male; Medical sciences; Middle Aged; Nerve Block - methods; Pain - prevention & control; Pressure - adverse effects; Time Factors; Tourniquets - adverse effects; Tourniquet; Human; Prevention; Regional anesthesia; Pain; Treatment; Brachial plexus; Technique
• ISSN: 0266-7681; 1532-2211
• DOI: 10.1016/0266-7681(94)90087-6

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the “mini-Bier's block”), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.