Title: Efficacy of Bier’s Block in the Surgical Management of Distal Radius Fractures
Authors: Swetha Purohit MD (Anaesthesia), Ramachandra Badami, DNB (Orthopaedics)
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.114
Abstract
Introduction: Fracture of distal radius is a very common injury, presenting to the emergency department. Most of the fractures are treated by closed manipulation and internal fixation. This requires absolute pain relief for a slightly prolonged duration. Various modalities have been advocated including hematoma block, Bier’s block, brachial block, general anaesthesia. We studied the efficacy of Bier’s block in the surgical management of distal radius fractures.
Materials and Methods: We prospectively studied 30 patients with distal radius fractures treated with closed manipulation and K-wire fixation under Bier’s block. IVRA was performed by using Inj. lignocaine and the dose was calculated as 3 mg/kg body weight. The hemodynamic changes following the block were monitored. The pain relief was assessed using VAS scaore and the quality of surgical anaesthesia.
Results: The average pre-block VAS score was 7.6 and the average post-block VAS score was 2.2. This difference in VAS score was statistically significant (P>0.005). Regarding quality of surgical anaesthesia, 74% of the patients were in Category-1, 25% patients were in Category-2, only 1 patient was in Category-3 and there were no patients in Catogery-4.
Discussion: IVRA has been regularly used for treatment of distal radius fractures. The primary advantages are its simplicity, reliability, cost-effectiveness. The present study has shown that the quality of intra-operative anaesthesia and analgesia was good with IVRA for distal radius fractures except for a mild tourniquet discomfort in few. But requires intense intra-operative and immediate post-operative monitoring. We had tachycardia in 6 patients and hypertension in 4 patients during the same period.
Conclusion: Bier’s block provides adequate pain relief but requires intense monitoring. It appears to be an attractive option to be practiced safely in field situation when it may be difficult to perform GA or equipment guided plexus blocks.
Keywords: Bier, Block, IVRA, Distal radius.
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