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Wednesday, April 16, 2014
I am having "ulnar nerve transposistion" on my elbow and carpal tunnel surgery with a "Bier Block" and I requested to be awake for the procedure. The surgeon said that they usually gave some sedation but didn`t seem to have a strong opinion; I asked the CRNA and she said that I could decide on no sedation, but that it`s a long procedure and might be painful (which is ok with me). Any experience with this without the sedation part? Thanks.
A Bier block is good for short (30-40 minute) procedures on the hand, forearm or wrist. With a successful Bier block the main source of discomfort is the inflated cuff placed on your arm. The pressure has to be around 100mm Hg higher than your normal systolic pressure. Have you ever had your blood pressure taken? Imagine that sensation, prolonged. It can get pretty uncomfortable which is why most patients get a bit of sedation along with it.
Apart from the discomfort, the cuff cannot remain inflated beyond about 90 minutes at the very most because the tissues in the arm during this time are getting very little blood flow. This limits the extent of surgery which can be done.
The final issue in your case is whether a Bier block is suitable for surgery on the elbow. The cuff may limit your surgeon's access to the area where he or she is operating.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University