Bier block double vs single tourniquet?

[Varmit22]

Our hospital has policy to use double tourniquet for IV regional, new hand surgeon wants to use single tourniquet so he has more room for his ulnar nerve releases. Thoughts, concerns, any experience with single tourniquet?

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[Urzuz]

I did a handful in training using a double tourniquet, never used a single. I would imagine if he is fast enough, it could maybe be done before tourniquet pain sets in? Not sure though.

A more important question for him though is why the hell does he even want to do a Bier block?

 

[Planktonmd]

As long as the case does not last more than 2 hours you will be fine.
Maybe you want to consider a supraclavicular, infraclvicular, or axillary block instead?

 

[Chloroform4Life]

Propofol and local does the trick just fine. You're not getting paid any extra for your surgical block. You're just incuring more liability in case of nerve injury and local anesthetic toxicity.

 

[deleted162650]

If you absolutely had to do a block then USG median and ulnar blocks are fun, quick, and easy.

 

[Ignatius J]

Our hospital has policy to use double tourniquet for IV regional, new hand surgeon wants to use single tourniquet so he has more room for his ulnar nerve releases. Thoughts, concerns, any experience with single tourniquet?

I do single tourniquets for CTRs and TFRs all the time. Single tourniquets work great. We put it just distal to the elbow. My advice is to put it as distal as possible which will require as little anesthetic as possible. I give 20-25cc 0.5% lidocaine and have literally never had a problem other than a blown IV every now and then.

At the end I just deflate the tourniquet at once. Never have had a problem.

As a forewarning. The surgeon has to be reasonably quick. At 20 minutes the patient will begin to complain of tourniquet pain.

 

[Ignatius J]

I did a handful in training using a double tourniquet, never used a single. I would imagine if he is fast enough, it could maybe be done before tourniquet pain sets in? Not sure though.

A more important question for him though is why the hell does he even want to do a Bier block?

They are beautiful with a fast surgeon. Pre-op to exit door home in 25 minutes.

 

[Noyac]

He wants a bier block so he can assess nerve function after the procedure. You can't do this with any other block. I prefer a straight GA with LMA for these cases.

The single tourniquet is fine. I haven't had an issue with it. We use it for CTR cases but the tourniquet is on the forearm. I rarely use the bier block for any other case but it sounds like your surgeon doesn't want the pt to go to sleep. I used to think that this wasn't the surgeons decision until one told me he liked regional for many reasons, one being that his pts brag to others that they didn't even go to sleep for Dr soandso's case. Pt perspective matters.

 

[Crash cart]

Bier blocks are annoying, but they work pretty well and a single TQ is more than adequate so long as the surgeon is reasonably quick.


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