Drug of choice for Bier's block ?
Ans. is 'd' i.e., Lidocaine Intravenous regional Anaesthesia (Bier's block) Intravenous regional anaesthesia (IVRA) is used most often for surgery of the forearm and hand, but can also be used for distal leg and foot. First IV canula is inseed usually in the dorsum of hand. Then tourniquet cuff is applied to proximal arm. Limb is elevated and exsanguinated with the help of an elastic bandage (Esmarch). Now tourniquet cuff is inflated above systolic pressure (so that no blood can enter in that limb and the limb remains exsanguinated). Now the local anaesthetic solution is slowly injected into cannula. The veins are filled with only local anaesthetic as there is no blood -ocal anaesthetic can not be drained out from upper limb and can not enter in systemic circulation because of inflated cuff in proximal arm. The arm is anaesthetized in 6-8 minutes. Lidocaine without adrenaline is the DOC for this technique. --Goodman & Gilman llthie 381 o A few clinician prefers prilocaine over lidocaine because of its higher therapeutic index - least toxic LA. Torniquet cuff deflation, premature release or failure of torniquet can cause release of LA into circulation and toxicity may occur- So, cardiotoxic LAs like bupivacaine and etidocaine are contraindicated for Bier's block.
Bupivacaine
Etidocaine
Ropivacaine
Lidocaine