A Bier block is a reliable regional anesthetic procedure involving intravenous administration of local anesthetic distal to an inflated pneumatic tourniquet. It is useful for fracture reductions, large laceration repairs, and foreign body removal. Duration of regional anesthesia is 30 to 60 min. In addition to routine monitoring and resuscitation equipment, the procedure requires a double-cuff tourniquet with a constant pressure gas source ( Table.. 32-1.2). A standard blood pressure cuff is not acceptable and can result in catastrophic systemic leakage of local anesthetic. Contraindications are listed in T.a,b.l..e...3.2.:.1.,3. The need for patients to have nothing by mouth for 4 h prior to the procedure may limit the usefulness of the technique. Use of this technique has also been applied to the lower limb in children, but it is less frequently used for the lower limb with larger children or adults.
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