ESRA Academy. Alp H. Sep 8, 2016; 138550; 0418 Topic: Miscellaneous Complications/ Medicolegal
Assoc. Prof. Hayriye Alp
Assoc. Prof. Hayriye Alp

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Background and Aims:

BIER Block is one of the regional anesthesia procedure of distal upper extremity surgery, which was identified by August Karl Bier(1). Advantages of this technique are  rapid onset, and rapid return to normal function. Disadvantages are pain and the potential for systemic local anesthetic toxicity(2). In this case, we reported blood extravasation complication due to the bier block.


A 61 year-old 90kg female patient was admitted the orthopedic clinic due to the left hand 4th and 5th fingers Dupuytren contracture. She was operated by using Bier block. 270mg of 2% Prilocain (3mg/kg, 13.5ml) combined with 26.5ml saline. Total 40ml solution were administered into the intravenous line, which was established on the dorsum of left hand, following exsanguination of left arm, forearm and hand by using esmarch bandage. Before injection, the double cuffed tourniquet applied to upper arm and inflated to 250mmHg following exsanguination.


During the surgery, surgeon complained to bleeding, tourniquet was checked and no leakage was detected. Forearm wrapped with sterile elastic bandage by surgeon. Surgery was completed within 50 minutes and bandages were diswrapped. After surgery, whole forearm and arm were covered with petechial lesions. Local therapy(chondroidin polysulfate) was implemented, after 5 days, lesions improved without any complication. 


Bier block regional anesthesia is a safe, efficient, and cost-effective method(3). One of the important part of procedure is exsanguination of extremity before injection. Inadequate exsanguination may cause complications such as blood extravasation, and petechia. Besides, no-extra bandage has to be used distal of the tourniquet.

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