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Journal of Hand Surgery (British and European Volume)
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Articles

The "Mini-Bier’s Block": A New Technique for Prevention of Tourniquet Pain During Axillary Brachial Plexus Anaesthesia

N. K. JAMES
C. T. K. KHOO
R. H. FELL

From the Departments of Plastic Surgery and Anaesthetics, Wexham Park Hospital, Slough, Berkshire UK

Correspondence: Mr C.T.K. Khoo FRCS, Department of Plastic Surgery, Wexham Park Hospital. Slough, UK.

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.

Journal of Hand Surgery (British and European Volume), Vol. 19, No. 3, 347-349 (1994)
DOI: 10.1016/0266-7681(94)90087-6
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